What are Medicare Star Ratings?
Every October, CMS publishes 1-to-5 star quality ratings for Medicare Advantage and Part D plans. Stars tell you how a plan handled its existing members on average — they don't tell you whether the plan will work for you. I'll explain what the ratings actually measure, what they don't, and how to use them as one signal among many.
Dr. Ed Weir, PhD · 20 years inside Social Security · "Former" Sergeant, USMC
Updated April 2026
What are Medicare Star Ratings?
Medicare Star Ratings are 1-to-5 quality scores CMS publishes each October for Medicare Advantage and Part D plans. They aggregate roughly 40 measures (about 13 for stand-alone Part D) across screenings, chronic-condition care, member experience, complaints, and customer service. They are one signal of plan operations, not a personal-fit ranking — your providers, drugs, and area still drive what plan fits.
If you want a human to walk through what stars mean for the plans available where you live:
Free help from licensed Medicare advisors
Star Ratings are useful information, but they don't answer the question that matters most: will this plan cover my doctors, my prescriptions, in my area, at a cost I can afford? Chapter's licensed Medicare advisors are paid by Chapter, not the plans, so they can walk through your situation and explain what stars do and don't mean for the options you're actually weighing. The conversation is free and there's no pressure to enroll in anything.
Here's what to do, in 4 steps.
If you want to use stars in your decision the right way, here's the order I'd go in. Start with the basics about your plan, then layer stars on top — never the other way around.
1. Look up the plans available where you live
Before you weigh stars, you need to know which plans actually operate in your county. Medicare Plan Finder lets you enter your ZIP and see every Medicare Advantage and stand-alone Part D plan available, with the current Star Rating shown next to each one. Stars only matter if the plan is available to you in the first place.
Medicare Plan Finder ›2. Check your doctors, drugs, and pharmacy first
Before you let stars influence anything, run the personal-fit filter. Are your doctors in network? Are your prescriptions on the formulary at a tier you can afford? Is your preferred pharmacy in the preferred network? A 5-star plan that fails any of these is the wrong plan for you. A 3.5-star plan that passes all three may be the right one.
Medicare Plan Finder ›3. Use stars as a tiebreaker, not the headline
Once you have two or three plans that pass the personal-fit filter, then look at Star Ratings as one input. Higher stars suggest the plan handled member service and clinical-care metrics better than lower-rated peers on average. They don't predict your specific experience. Use them to break ties between otherwise comparable plans.
CMS Star Ratings overview ›4. Call SHIP if you want unbiased guidance
Your State Health Insurance Assistance Program (SHIP) gives free counseling from people who don't sell plans. They can walk through what stars mean, explain the 5-star Special Enrollment Period if it applies to you, and help you compare options without pressure. Call for the SHIP office that serves your state.
SHIP locator ›The numbers behind the stars
Which of these sounds more like you?
Star Ratings hit different people in different ways. Pick the situation that sounds most like yours.
I'm picking my first Medicare plan and I've heard about starsNew to Medicare and trying not to fly blind
If this is your first time picking a Medicare plan, Star Ratings can feel like a finish line. They aren't. They're one signal CMS publishes about how a plan handled its existing members on average across screenings, chronic-care monitoring, member experience, complaints, and customer service.
Start with what fits your life: which plans operate in your county, which cover your doctors, which list your drugs at a tier you can afford. Once you have two or three that pass that filter, layer Star Ratings on as one input. Stars matter most when other things are equal.
I've seen people pick the highest-star plan in their area, then learn after enrollment that their cardiologist isn't in network. Stars don't tell you that. Your providers and drugs do.
Someone told me to just pick a 5-star planWhen the advice sounds too clean
If anyone tells you to just pick a 5-star plan and stop there, slow down. They're skipping the part of the work that actually determines whether the plan fits you. Stars measure plan operations and average member experience. They do not measure whether YOUR doctors are in network, whether YOUR prescriptions are covered at acceptable cost, or whether the plan operates in YOUR area.
A shortcut that ignores those three questions isn't a shortcut. It's a coin flip dressed up as advice.
Anyone who says "pick a 5-star plan" without asking about your doctors, drugs, and area is selling you a shortcut, not a fit. Stars are one factor, not the factor.
I heard there's a special enrollment period for 5-star plansYear-round window, narrow eligibility
Yes — the 5-star Special Enrollment Period (SEP) lets a beneficiary switch into a Medicare Advantage plan or stand-alone Part D plan that has a 5-star overall rating once during the year, year-round (December 8 of the prior year through November 30 of the contract year). It is not a window to switch between 5-star plans, and it does not let you switch into a non-5-star plan.
Whether any 5-star plan is available where you live varies by county and by year. Plan Finder shows current ratings for plans available at your ZIP. SHIP can walk through whether the 5-star SEP applies to you and what enrolling would actually mean for your coverage.
I can tell you the rule. I can't tell you whether enrolling is the right move — that depends on your providers, drugs, and area. SHIP at walks through it free.
My current plan got a low rating — should I switch?Low stars are information, not a verdict
A low Star Rating is information, not an automatic switch order. CMS flags plans with a Part C summary rating below 3 stars as low performers; if a plan stays below 3 stars for three consecutive contract years, CMS has the authority to terminate the contract under 42 CFR 422.510(a)(4)(xi).
If your current plan is rated below 3 stars and the low-performing icon shows on Plan Finder, you have a year-round Special Enrollment Period available to switch to a different plan while you're enrolled in the low-performing one. But before switching, run the same personal-fit check: does the alternative cover your doctors, your drugs, in your area? Otherwise you may trade an aggregate score for a worse personal fit.
I've seen people switch out of a low-star plan and into one that's rated higher — but doesn't cover their specialist. The rating got better. Their care got worse.
I want to understand what the stars actually measureMethodology in plain English
CMS scores Medicare Advantage plans with prescription drug coverage on roughly 40 measures grouped into domains: staying healthy (screenings, vaccines, annual visits), managing chronic conditions (diabetes care, blood pressure control), member experience (CAHPS surveys), member complaints and access, and plan customer service (appeals, call centers). Stand-alone Part D plans are scored on roughly 13 measures focused on drug-plan operations.
Each measure is scored 1 to 5. CMS applies a clustering methodology with guardrails on year-over-year cut-point movement. The weighted average across measures produces the overall plan rating, also on a 1-to-5 scale. CMS publishes the Technical Notes each year if you want the full methodology.
Stars illuminate one corner of plan quality. The whole picture needs your providers, your prescriptions, your area, and your priorities. SHIP at can help with the rest.
There aren't any high-star plans where I liveGeography decides what's on the table
Star Ratings are calculated at the contract and plan level, and the mix of plans available varies by county. Some counties have several plans rated 4 stars or higher; others have few. If your area has limited high-star options, that's the menu you have to work with.
What matters most is still personal fit: of the plans actually available to you, which one covers your doctors, your drugs, and your pharmacy at a cost you can sustain? Stars become a tiebreaker after that filter, not a substitute for it. SHIP can help compare what's actually on the table for your ZIP.
I've seen people in rural counties get talked into switching to a higher-star plan two states over by accident — the plan didn't even operate in their county. Always check availability first.
I'm helping a parent or spouse compare plansDoing this without overstepping
If you're researching plans for a parent or spouse, Star Ratings can feel like a clean way to narrow the list. Resist that. The plan has to fit the person you're helping, not the rating. Make a list of their providers, their current prescriptions with dosages, their pharmacy, and any conditions that affect coverage choices.
Then run that list against each available plan. Stars come last — useful as a tiebreaker between two plans that both pass the personal-fit check. SHIP at will counsel you and the person you're helping at no cost. They don't sell plans, so they can give it to you straight.
I can illuminate the rules and the order of operations. The decision belongs to the person enrolling. SHIP can help both of you walk through it.
None of these match — I'm just trying to understand starsWhere to start when you're early in the process
If you're researching Star Ratings before you have to make a decision, that's the right move. Here's the short version: stars are a 1-to-5 quality score CMS publishes every October on Medicare Advantage and Part D plans. They aggregate operations and member-experience data across many measures. They do not predict your individual experience.
When you're ready to compare specific plans, the order is: which plans are available in your county, which cover your doctors and drugs, what they cost you out of pocket, and only then — stars. SHIP at will walk through any of this without selling you a plan.
Stars are one signal among many. The personal-fit questions are bigger. Take your time with the ordering and you won't regret it.
Other programs that may help
Medicare doesn't sit alone. If money is tight, a few other programs may take pressure off premiums, drugs, or food — and they don't change which plan you pick.
Medicare
You may qualify for Medicare at 65, or earlier with a qualifying disability or End-Stage Renal Disease. Star Ratings apply to Medicare Advantage plans (Part C) and stand-alone prescription drug plans (Part D), not to Original Medicare.
Medicare Savings Programs (MSP)
If your income is limited, you may qualify for a Medicare Savings Program that pays your Part B premium and, depending on the program, cost-sharing. MSP eligibility is run by your state Medicaid office. It does not change which plan you choose.
Extra Help (Part D Low-Income Subsidy)
If your income and resources are limited, you may qualify for Extra Help, which lowers Part D premiums, deductibles, and copays. SSA handles applications. Extra Help is separate from Star Ratings — it changes what you pay, not which plan you pick.
Medicaid
If your income and resources are limited, you may qualify for Medicaid alongside Medicare. People enrolled in both are called dual-eligible, and special plans (D-SNPs) coordinate the two. Eligibility is run by your state Medicaid office.
SNAP
If groceries are tight, you may qualify for SNAP food assistance. Older adults and people with disabilities often qualify at higher income limits than they expect. SNAP is administered by your state. It is unrelated to which Medicare plan you choose.
SHIP (State Health Insurance Assistance Program)
Every state has a SHIP that gives free, unbiased Medicare counseling. SHIP counselors do not sell plans, so they can walk through Star Ratings and what they mean for the options available to you. Call to reach the SHIP serving your state.
Everything people ask me about Star Ratings
What do Medicare Star Ratings actually measure?
CMS scores Medicare Advantage plans with prescription drug coverage on roughly 40 measures across staying healthy (screenings, vaccines, annual visits), managing chronic conditions (diabetes, blood pressure), member experience (CAHPS surveys), member complaints and access, and plan customer service. Stand-alone Part D plans are scored on roughly 13 measures focused on drug-plan operations. Each measure is scored 1 to 5; the weighted average produces the overall plan rating, also on a 1-to-5 scale.
How often are Star Ratings updated?
Once a year. CMS publishes new Star Ratings each October that apply for the following plan year. So the ratings released in October 2025, for example, apply to the 2026 plan year. CMS also publishes the Technical Notes each year with the methodology details.
Does a 5-star plan guarantee it's the right plan for me?
No. Stars measure how a plan handled its existing members on average across operations, clinical-care metrics, and member surveys. They do not measure whether your doctors are in network, whether your prescriptions are covered at acceptable cost, or whether the plan operates in your area. A 5-star plan that fails any of those personal-fit questions is the wrong plan for you.
What is the 5-star Special Enrollment Period?
It's a year-round window that lets a beneficiary switch into a Medicare Advantage plan or stand-alone Part D plan rated 5 stars overall. Under 42 CFR 422.62(b)(15) and 42 CFR 423.38(c)(20), it can be used once per contract year, beginning December 8 of the prior year through November 30 of the contract year. It does not allow switching between 5-star plans, and it does not let you switch into a non-5-star plan.
What if there's no 5-star plan where I live?
Plan availability and Star Ratings vary by county. Some areas have several 4-star or higher options; others have few or none. If no 5-star plan is available where you live, the 5-star SEP doesn't help you — you'd use the regular enrollment periods (Annual Enrollment Period October 15 through December 7, or other applicable periods) to choose among the plans you do have.
Can a low-star plan be terminated by CMS?
Yes. Under 42 CFR 422.510(a)(4)(xi), CMS may terminate an MA contract if the plan achieves a Part C summary plan rating of less than 3 stars for 3 consecutive contract years. CMS also flags persistently low-performing plans with a low-performing icon on Plan Finder, and beneficiaries enrolled in a flagged plan get a year-round Special Enrollment Period to switch.
Where do I find the Star Rating for a specific plan?
Medicare Plan Finder at medicare.gov/plan-compare shows the current Star Rating next to each Medicare Advantage and stand-alone Part D plan available at your ZIP code. CMS also publishes plan-level data files on cms.gov each year with the full ratings broken down by measure and domain.
Do Star Ratings apply to Original Medicare or Medigap?
No. Star Ratings only apply to Medicare Advantage plans (Part C) and stand-alone Part D prescription drug plans. Original Medicare (Part A and Part B) and Medigap supplement policies are not rated under this system. If you're choosing between Original Medicare with a Medigap and a Medicare Advantage plan, the Star Rating tells you something about one side of that decision and nothing about the other.
How should I actually use Star Ratings in my decision?
As one input, layered last. Start with which plans operate in your county, then check which cover your doctors and which list your drugs at a cost you can afford. Once you've narrowed to two or three plans that pass that personal-fit filter, look at Star Ratings as a tiebreaker. Higher stars suggest better operations and member experience on average; they do not predict your individual experience.
Where can I get unbiased help understanding stars?
Your State Health Insurance Assistance Program (SHIP) gives free, unbiased Medicare counseling. SHIP counselors don't sell plans, so they can walk through what stars mean for the options available where you live, explain the 5-star SEP if it applies, and help you compare plans against your providers and drugs. Call to reach the SHIP that serves your state.
Sources
Every figure and rule on this page is verified against primary sources. Last verified 2026-04-28.
- Star Ratings only apply to Medicare Advantage plans (Part C) and stand-alone Part D prescription drug plans. Original Medicare (Part A and Part B) and Medigap supplement policies are not rated under … —cms.gov(verified 2026-04-28)
- Medicare Advantage Star Ratings cover roughly 40 measures across domains including staying healthy (screenings, vaccines, annual visits), managing chronic conditions, member experience (CAHPS), member … —cms.gov(verified 2026-04-28)
- CMS publishes new Medicare Star Ratings each fall, with the ratings applying for the following plan year (i.e., ratings released in October apply to the next calendar year's plan offerings). —cms.gov(verified 2026-04-28)
- Plan Finder at medicare.gov/plan-compare displays the current Star Rating next to each Medicare Advantage and stand-alone Part D plan available at a beneficiary's ZIP code. —medicare.gov(verified 2026-04-28)
- CMS publishes Medicare Star Ratings on a 1-to-5 scale (with half-star increments) for Medicare Advantage and Part D plans, with the overall plan rating produced by a weighted average across underlying … —ecfr.gov(verified 2026-04-28)
- An individual may use the 5-star Special Enrollment Period only once for the contract year in which the MA plan was assigned a 5-star overall performance rating, beginning December 8 before that … —ecfr.gov(verified 2026-04-28)
- The same once-per-contract-year, December 8 through November 30 5-star SEP applies for stand-alone Part D plans (PDPs) under 42 CFR 423.38(c)(20). —ecfr.gov(verified 2026-04-28)
- CMS may terminate a Medicare Advantage organization's contract if the MA organization achieves a Part C summary plan rating of less than 3 stars for 3 consecutive contract years. —ecfr.gov(verified 2026-04-28)
- An individual enrolled in a plan that has been identified with the low-performing icon under 42 CFR 422.166(h)(1)(ii) is eligible for a Special Enrollment Period that exists for as long as the … —ecfr.gov(verified 2026-04-28)
- The same low-performing-icon SEP applies for Part D plans under 42 CFR 423.38(c)(32), keyed to the icon under 42 CFR 423.186(h)(1)(ii). —ecfr.gov(verified 2026-04-28)
- For non-CAHPS measures effective for Star Ratings issued in October 2022 and subsequent years, CMS applies a guardrail so that measure-threshold-specific cut points do not increase or decrease more … —ecfr.gov(verified 2026-04-28)
- Effective for Star Ratings issued in October 2023 and subsequent years, CMS removes Tukey outer fence outliers prior to applying mean resampling with hierarchical clustering when determining cut … —ecfr.gov(verified 2026-04-28)
- The Medicare Advantage Annual Coordinated Election Period for the following calendar year runs October 15 through December 7. —ecfr.gov(verified 2026-04-28)
- Star Ratings measure plan operations and member experience in aggregate. They do not measure whether an individual's specific providers are in network, whether their specific prescriptions are … —ecfr.gov(verified 2026-04-28)
- State Health Insurance Assistance Programs (SHIPs) offer free, unbiased Medicare counseling. The national SHIP locator phone is . —shiphelp.org(verified 2026-04-28)
Helping a parent or spouse compare plans?
If you're the one researching plans for a parent or spouse, Star Ratings can feel like a shortcut — pick the highest stars and move on. They aren't. Whether the plan covers their cardiologist, their inhaler, and their county matters more than the rating. I built a version of this walk-through aimed at family helpers who want to do this right without overstepping.
→ Get help for someone elseHelp me keep it.
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