You can trust that you’re getting high-quality health insurance when you enroll in a five-star Medicare Advantage plan. Because a five-star rating is the top rating for Medicare Advantage (also called Medicare Part C), it’s a good way to judge whether that plan is the real deal.
By law, you have extra opportunities to join a five-star Medicare Advantage plan. If you’re thinking about leaving your current plan to enroll in another that’s rated five stars, we can help you make and act on an informed decision.
What Does a Five Star Medicare Advantage Plan Mean?
Medicare Advantage plans are rated from 1 to 5 stars, with five stars being an “excellent” rating. This means a five-star plan has the highest overall score for how well it offers members access to healthcare and a positive customer service experience.
Here’s a look at what each star rating means to help you better understand a five-star rating.
- ★★★★★ — excellent
- ★★★★ — above average
- ★★★ — average
- ★★ — below average
- ★ — poor
How Are Medicare Advantage Plans Rated Five Stars?
Fortunately, Medicare Advantage plans don’t get an excellent rating by just wishing upon a star.
The Centers for Medicare & Medicaid Services (CMS) has many categories for quality and performance that a plan must meet before it can get a rating of five stars. Medicare star ratings help protect you as a customer because they let you understand how a plan compares to its peers.
A Medicare Part C plan earns five stars if it has the best overall score for health services and drug coverage (if the plan offers this benefit) in these areas:
| Medicare Advantage Health Services – Rated in 5 Areas | Medicare Advantage Drug Benefits – Rated in 4 Areas |
|---|---|
| 1. Staying healthy: screening tests and vaccines | 1. Drug coverage customer service |
| 2. Managing chronic (long-term) conditions | 2. Member complaints and changes in the drug plan’s performance |
| 3. Member experience with the health plan | 3. Member experience with the drug plan |
| 4. Member complaints and changes in the health plan’s performance | 4. Drug safety and accuracy of drug pricing |
| 5. Health plan customer service |
The information Medicare uses to rate a plan five stars comes from these sources:
- Member surveys
- Information plans and healthcare providers submit to Medicare
- Medicare’s regular monitoring
- Billing and other information about drug coverage that plans submit to Medicare
Are There Any Five-Star Medicare Advantage Plans?
Yes! Of the 26 million people who have Part C coverage in 2021, 10 percent are enrolled in a plan that’s rated five stars.1
However, it may be easier to find plans with a 4 or 4.5 star rating because more people are enrolled in Medicare Part C plans that have these ratings.
How and When Can You Join a Five Star Medicare Advantage Plan?
You can make this switch during the Five Star Special Enrollment Period (SEP), which takes place from December 8 to November 30. It’s in addition to the main Medicare Advantage Open Enrollment Period, when you can switch to all types of Medicare Advantage plans.
Speak with a licensed Medicare agent to help you switch coverage using the Five Star SEP.
If you’re unable to sign up online, contact the plan directly for enrollment paperwork.
