Medicare Advantage Star Ratings Explained

Learn how CMS calculates Medicare Advantage star ratings, why they matter, and how to use them to compare plans during Open Enrollment.

By the SeniorAffair.com Medicare Team · Reviewed for accuracy against CMS.gov and Medicare.gov

Every Medicare Advantage and Part D plan gets a public quality score from CMS, from 1 to 5 stars, updated once a year. It’s one of the fastest ways to gauge a plan’s real-world performance before you commit to it during Open Enrollment — but most people never look at it, and most who do don’t know what it’s actually measuring.

What the Star Rating System Measures

CMS calculates star ratings using dozens of individual measures grouped into broad categories:

• Staying healthy: screenings, tests, and vaccines members received
• Managing chronic conditions: how well the plan supports members with diabetes, heart disease, and other ongoing conditions
• Member experience: survey results on ease of getting care and satisfaction with the plan
• Member complaints and plan performance: complaint volume, disenrollment rates, and how quickly the plan resolves appeals
• Customer service: call center responsiveness and accuracy

Part D-specific measures also factor in medication safety and accuracy of drug pricing information provided to members. A plan’s overall star rating is a weighted average across all these individual measures.

How to Read the Rating

Plans rated consistently below 3 stars for three years in a row are flagged by CMS as “low performing,” and CMS may limit how those plans can be marketed to new members.

Where to Find a Plan’s Star Rating

Star ratings are published on Medicare.gov’s Plan Finder tool alongside each plan’s cost estimate—you don’t need a separate lookup. They’re also listed on CMS’s public Medicare Plan Ratings data release each fall, ahead of the start of AEP. When comparing plans while switching, as covered in How to Switch Medicare Advantage Plans During Open Enrollment, the rating appears right next to each plan’s cost and coverage details.

See star ratings alongside cost and network details for every plan available in your ZIP code.

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Why Star Ratings Matter Beyond Bragging Rights

1. They correlate with real member experience

Because a large share of the rating comes from actual member surveys and complaint data, not just marketing claims, a consistently 4- or 5-star plan tends to mean fewer customer service headaches, more accurate claims processing, and better-managed chronic care programs.

2. 5-star plans unlock a special enrollment opportunity

If a 5-star Medicare Advantage or Part D plan is available in your area, you can enroll in it during a special year-round enrollment period, once per year, outside the normal AEP window. This is covered in more detail in Medicare Special Enrollment Periods: Do You Qualify?.

3. CMS uses ratings to determine bonus payments to plans

Plans rated 4 stars or higher receive bonus payments from CMS, which can translate into more generous supplemental benefits — part of why higher-rated plans often, though not always, offer richer extras like dental and vision allowances.

What Star Ratings Don’t Tell You

• They don’t guarantee your specific doctor is in-network. Rating and network adequacy are measured separately.
• They don’t reflect this specific year’s premium or copay changes. Ratings are based on the prior year’s performance data, not next year’s pricing.
• They’re an average across the whole plan membership, not personalized to you. A plan can be excellent at managing diabetes care and mediocre at customer service — the overall star rating blends both into one number.
• A high rating doesn’t mean the plan is the cheapest option for your specific medications. Cost and quality are separate axes worth comparing independently.

How Ratings Change Year to Year

CMS recalculates ratings annually based on the most recent full year of data, so a plan’s rating can rise or fall from one Open Enrollment to the next. A plan that was 4 stars last year isn’t guaranteed to stay at 4 stars, which is another reason to re-check ratings during your annual review rather than relying on what you remember from a previous year.

Start with the 4-and-5-star plans in your area, then compare their costs and networks in one place.

Filter by Star Rating →

Using Star Ratings Alongside Cost Comparisons

The most effective way to use star ratings is as a filter, not a final answer. Start by identifying plans in your area rated 4 stars or higher, then compare those specific plans on cost, network, and formulary using the process outlined in Medicare Part D Open Enrollment: Comparing Drug Plans and How to Switch Medicare Advantage Plans During Open Enrollment. This narrows your options to plans with a track record of decent service before you spend time on detailed cost comparisons.

A Word of Caution About Marketing Claims

Insurance marketing materials sometimes highlight a strong rating in one specific category (like “highest-rated for member satisfaction in our region”) without disclosing the plan’s overall star rating, which might be lower. Always check the plan’s official overall CMS star rating on Medicare.gov directly rather than relying on a claim printed in a mailer or ad, since marketing materials can selectively highlight favorable statistics.

How Star Ratings Are Calculated, in More Detail

CMS collects data from several sources throughout the year: the Consumer Assessment of Healthcare Providers and Systems (CAHPS) member survey, HEDIS clinical quality measures, the Health Outcomes Survey, and administrative data the plans themselves report, including complaint tracking through the CMS complaints system. Each individual measure is scored on a 1-5 scale, then measures are weighted — with member experience, complaints, and access measures generally weighted more heavily than process measures — and combined into the plan’s overall Part C rating (for medical coverage) and, if applicable, a separate Part D rating for drug coverage. A Medicare Advantage plan that includes drug coverage (MAPD) gets a combined overall rating that factors in both.

Why Some Plans Choose Not to Participate Fully

Not every Medicare Advantage plan qualifies for a full star rating in its first few years of operation, since CMS requires enough historical member data to calculate certain measures reliably. New plans, or plans with a very small membership base in a given county, may show as “not enough data” rather than a numeric rating. This isn’t necessarily a red flag, but it does mean you’re taking on more uncertainty by enrolling in a newer plan compared with one that has several years of published performance data to evaluate.

Comparing Star Ratings Across Plan Types

HMO, PPO, and Special Needs Plans (SNPs) are all rated using the same underlying CMS methodology, which makes ratings a useful apples-to-apples comparison tool even when you’re weighing very different plan structures. That said, a SNP designed for people with specific chronic conditions is evaluated in part on measures tailored to that population, so comparing a SNP’s rating directly against a general-enrollment HMO’s rating should be done with that context in mind rather than treating the number as perfectly interchangeable across plan types.

A Quick Star Rating Reference for Your Open Enrollment Review

1. Look up the overall star rating for any plan you’re considering on Medicare.gov’s Plan Finder
2. Favor plans rated 4 stars or higher when the cost difference is small
3. If a plan you’re interested in is rated 5 stars, remember you can switch into it once per year outside AEP too
4. Cross-check the rating against your own priorities — if customer service matters most to you, look at that specific sub-measure, not just the overall blended score
5. Re-check ratings every year, since they’re recalculated annually and can shift

Star Ratings and Your Broader Enrollment Decision

Star ratings work best as one input alongside the cost and network comparisons covered elsewhere in this guide, not as a standalone deciding factor. A 5-star plan that doesn’t include your doctor or doesn’t cover your medications well isn’t the right choice just because of the rating, and a solid 3.5-star plan that nails your specific network and formulary needs can easily be the better real-world fit. Treat the rating as a quality baseline — a way to quickly rule out plans with a track record of member dissatisfaction — then do the detailed cost and coverage comparison outlined in the main Open Enrollment guide on whatever shortlist remains.

Frequently Asked Questions

More in This Medicare Open Enrollment Guide

• Medicare Open Enrollment 2027: The Complete Guide
• Medicare Advantage vs. Original Medicare: How to Decide
• How to Switch Medicare Advantage Plans During Open Enrollment
• Medicare Part D Open Enrollment: Comparing Drug Plans
• Medigap vs. Medicare Advantage: Which Costs Less?
• Medicare Open Enrollment Deadlines and Penalties
• Medicare Advantage Star Ratings Explained
• Medicare Special Enrollment Periods: Do You Qualify?
• Medicare Costs in 2027: Premiums, Deductibles, and Limits
• Medicare Open Enrollment Checklist: 10 Questions to Ask

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Information on this page is general in nature and not a substitute for personalized advice from Medicare.gov, 1-800-MEDICARE, or a licensed insurance agent.