What is the 5-star rating for Medicare companies?

The 5-star rating for Medicare companies is based on surveys of members and providers as well as what is covered by the plan. 1 star is the lowest ranking of these plans and 5 stars is the highest ranking, based on surveyed member satisfaction, provider satisfaction and what types of services are covered by the individual Medicare company. 

There is a new star rating released every fall by Medicare, and you can see the company rankings for the current year by visiting the Medicare website. 

What is the Medicare star rating system used to measure?

The Medicare star rating system is used to measure how well Medicare Advantage plans and Medicare Part D plans function. It takes into consideration the cost of the plan and coverage in measuring whether a member enrolled in this plan will receive adequate care.

What categories are measured in the star rating system?

Medicare Advantage plans are ranked by five criteria: performance with preventative care such as screenings and vaccines, managing chronic conditions, plan responsiveness and care, member complaints and number of times people leave the plan, and the health plan’s customer service.

Medicare Part D plans are ranked by four criteria: drug plan customer service, member complaints and number of times people leave the service, member experience with their drug plan, and drug pricing and patient safety.

If my plan is poorly ranked, can I switch?

Yes, at times you can switch out of your Medicare Advantage or Medicare Part D plan if it is found to be poorly performing. If your plan is rated 2.5 stars or lower for 3 years in a row, it is designated as a “low-performer index” (LPI), and there is a special enrollment period to switch from your LPI plan to a different one. 

Medicare is required to notify you if your plan is considered to be poorly performing. Generally you will only be able to switch out of a plan that is poorly ranked once a year during your special enrollment period.

What is the 5-star special enrollment period?

There is a special enrollment period window that allows you to switch to a 5-star plan outside your usual open enrollment period. The 5-star special enrollment period allows people with Medicare to switch plans to a Medicare Advantage plan ranked 5 stars. This is because Medicare always wants to allow its members to move up to a higher-quality plan, so even if it is not your enrollment period, you can still switch to a Medicare Advantage plan ranked 5 stars between December 8 and November 30.

How are the plans ranked?

Plans are ranked by a complex criteria including member surveys, provider surveys, types of coverage included in the plan, health inspections of the services and hospitals included in the plans, measure of hours of care provided by staff on the plans, a 15-point quality inspection system of the clinics in the plans and more. The star quality is still a subjective ranking of the hospitals, clinics, nursing homes and staff included in these Medicare Advantage plans so members are still encouraged to draw their own conclusion about local options, but the star rankings can help you make an informed decision when shopping for a Medicare Advantage plan in your area.

How do you find a 5-star Medicare Advantage plan?

When you are comparing plans on the Medicare.gov website or talking to a licensed insurance agent, all star rankings are clearly identified and 5-star plans are indicated by a special icon—a gold triangle with the number 5 inside. This means the plan you are looking at is ranked 5 stars, so you can switch to it during the 5-star special enrollment period.