Compare Your Medicare Plan Using the Star Rating System
Key Takeaways
- Medicare Star Ratings help consumers compare healthcare plans.
- Providers and plans receive an overall Star Rating based on several different measurements.
- Five stars is the highest rating, while one is the lowest rating.
DeductiblesA deductible is an amount you pay out of pocket before your insurance company covers its portion of your medical bills. For example: If your deductible is $1,000, your insurance company will not cover any costs until you pay the first $1,000 yourself. , premiumsA premium is a fee you pay to your insurance company for health plan coverage. This is usually a monthly cost. , provider networksA provider network is a group of doctors, hospitals and other specialists who agree with an insurance company to treat its clients. It’s usually less expensive for you to see a doctor within your provider network. — the details you need to consider each year when choosing your Medicare plan can be dizzying. To help, the Medicare Star Ratings can be a guiding light. As you consider plans, here’s what you should know about what these ratings mean and how they’re determined.
Have questions about your Medicare coverage?
What is the Medicare Star Rating System?
The purpose of the Medicare Star Ratings is to help consumers make educated decisions when purchasing their health insurance plans. The Centers for Medicare & Medicaid Services (CMS) assigns a star rating of 1 to 5 across designated performance areas, including:
- Medicare Advantage plans
- Medicare Prescription Drug Plan (Part D)
- Physicians
- Hospitals
- Nursing home
- Home health
- Dialysis facility
CMS announced that, starting in 2027, the ratings will also factor in a health equity index to reward high-quality care for people with certain risk factors such as low income or living in a rural area.
Why Are Medicare Star Ratings Essential?
The Medicare Star Ratings are essential for two main reasons:
They provide “apples-to-apples” comparisons.
All plans and providers are judged against the same measurements. Ratings can be a big help when you’re making important decisions like enrolling in a Medicare Advantage plan, moving into a nursing home, or going to a hospital for an inpatient procedure.
They hold the healthcare providers and carriers accountable.
Since insurance carriers, facilities, and healthcare providers have their ratings published publicly, they have motivation to improve low-performing areas or risk losing future patients.
Find the Medicare Plan that works for you.
How Often Are Star Ratings Updated?
CMS updates its Star Ratings at different times. Ratings for insurance plans are typically released each fall to line up with enrollment periods for Medicare, Medicare Advantage, Medicare Prescription Drug Plan (Part D), and standard health insurance. Changes are made based on feedback, provider recommendations and data.
Some are updated even more regularly; CMS’ Nursing Home Compare tool reflects the latest nursing home ratings each month. Others are updated less often — CMS’ hospital quality rating, Hospital Compare, is often refreshed only once per year.
When using CMS Star Ratings, make sure to check how old the ratings are. If you have any doubt, ask your provider or carrier to see the latest ratings.
What Is the Difference Between 1 Star and 5 Stars?
CMS Star Ratings always range from one to five stars, with five stars being the highest rating:
- Five stars: Best
- Four stars: Above average
- Three stars: Average
- Two stars: Below average
- One star: Worst
CMS applies half-star ratings. A three-and-a-half star rating, for example, is higher than just three stars.
How Are Star Ratings Calculated?
Star Rating are calculated differently for each area, based on the feedback and the data on outcomes that CMS gathers throughout the year. CMS determines the overall rating from an in-depth analysis that includes a variety of categories.
For example, a Medicare Advantage plan is reviewed for how well it covers services such as diabetes care, breast cancer screenings, osteoporosis management, colorectal cancer screenings, and flu shots. CMS also considers factors like how members feel about the plan and how many choose to switch to a different one.
That means you may be able to find Star Ratings that tell you a lot about your own healthcare needs.
Have Your Own Ratings
The CMS Star Ratings can be an invaluable tool when searching for insurance plans and providers. They shouldn’t, however, be your only resource when making decisions. When researching your choices, make sure you’re searching for the services and facilities you need, or may need in the future. The ratings in specific categories may be more important to you than just the plan’s overall Star Rating.
You can also seek out other perspectives. Several other organizations provide ratings of their own based on different criteria. If you need help, GoHealth’s team of licensed insurance agents can break down your Medicare Advantage choices and understand their Star Ratings.
Have questions about your Medicare coverage?
What is the 5-star special enrollment period?
Can I change my Medicare Part D or Medicare Advantage plan if the star rating drops?
When do I get notified of star updates If I have a Part D or Medicare Advantage plan?
Sources
- Your Medicare Options. Medicare.gov.
- Five-Star Quality Rating System. CMS.gov.
- Overall Hospital Quality Star Rating. Medicare.gov.
- Special Enrollment Periods. Medicare.gov.
- 2024 Medicare Advantage and Part D Final Rule. CMS.gov
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