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Medicare Advantage Star Ratings

Medicare Advantage star ratings are one of the most important tools you have for choosing a quality health plan. But most people don’t know they exist, don’t understand what they mean, or don’t know how to use them to their advantage.

Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates every Medicare Advantage plan and assigns it a star rating from 1 to 5 stars. Five stars is the highest rating — it means the plan delivers excellent quality, service, and member satisfaction. One star is the lowest.

These ratings aren’t arbitrary. They’re based on real performance measures that affect your care, your costs, and your experience with the plan.

And here’s what most people miss: if you’re in a low-rated plan, you can switch to a 5-star plan almost any time of year — without waiting for the Annual Enrollment Period.

I treat every client like I would my own parents. And if my parents were choosing a Medicare Advantage plan, I’d make sure they understood star ratings, what they measure, and how to use them to find better coverage.

What Medicare Advantage Star Ratings Measure

Star ratings aren’t just a marketing tool. They measure real performance across dozens of categories that affect your healthcare experience.

Here’s what CMS looks at when rating Medicare Advantage plans:

Quality of Care

Does the plan help members stay healthy? Do they provide preventive services like screenings, vaccines, and wellness visits? Do they manage chronic conditions like diabetes and heart disease effectively?

Plans that score high on quality of care actively work to keep their members healthy — not just treat them when they’re sick.

Member Experience

Are members satisfied with the plan? Do they have access to the doctors and specialists they need? Is it easy to get appointments? Are customer service representatives helpful and responsive?

Member experience ratings are based on surveys of actual plan members. If people are unhappy, the rating reflects that.

Customer Service

How well does the plan handle questions, complaints, and appeals? How quickly do they respond? Are they easy to reach?

If you’ve ever spent hours on hold or gotten the runaround from your insurance company, you know how important this category is.

Claims Processing

Does the plan process claims quickly and accurately? Do members face unexpected denials or billing errors?

Plans with high ratings handle claims efficiently. Plans with low ratings often leave members dealing with billing headaches and denied claims.

Drug Plan Performance

For plans that include prescription drug coverage, CMS evaluates how well the plan manages its formulary, handles prior authorizations, and supports members in getting their medications.

Plans that score high make it easy to get your medications. Plans that score low create barriers.

Why Star Ratings Matter

Star ratings give you a way to compare plans based on quality — not just price.

Most people choose a Medicare Advantage plan based on the premium. They see a $0 premium plan and assume it’s a good deal.

But a low premium doesn’t mean a good plan. If the plan has poor customer service, denies claims frequently, or makes it hard to see doctors, that $0 premium isn’t saving you money — it’s costing you stress, time, and potentially worse health outcomes.

Star ratings help you see past the premium and evaluate what really matters: quality, service, and member satisfaction.

Plans with 4 or 5 stars consistently deliver better experiences. Plans with 2 or 3 stars often leave members frustrated and dealing with problems.

And here’s the bonus: Medicare rewards 5-star plans by letting you switch into them almost any time of year — even outside the normal enrollment periods.

The 5-Star Special Enrollment Period

This is one of the best-kept secrets in Medicare.

If there’s a 5-star Medicare Advantage plan available in your area, you can switch to it once per year during the 5-Star Special Enrollment Period — which runs from December 8 through November 30 of the following year.

That means you don’t have to wait for the Annual Enrollment Period (October 15 – December 7) to switch. You can do it almost any time.

Here’s how it works:

You can switch once per calendar year. You get one opportunity to use the 5-Star Special Enrollment Period each year.

You must switch to a 5-star plan. You can’t use this period to switch from one low-rated plan to another. It only works if you’re switching into a 5-star plan.

The plan must be available in your area. Not every county has a 5-star plan. Check Medicare.gov to see if one is available where you live.

Your new plan starts the month after you enroll. If you enroll on March 15, your new coverage starts April 1.

This is a powerful tool. If you’re stuck in a plan that’s not working and there’s a 5-star option nearby, you can switch without waiting until fall.

Learn more about Special Enrollment Periods and when you can switch plans.

How to Find 5-Star Plans Near You

Not every area has a 5-star Medicare Advantage plan. But they’re becoming more common.

Here’s how to check:

Step 1: Go to Medicare.gov and use the Plan Finder tool. Enter your zip code and search for Medicare Advantage plans in your area.

Step 2: Look at the star ratings. Each plan will display its star rating. Filter by 5-star plans to see what’s available.

Step 3: Compare the plans. Don’t just pick a 5-star plan because it has a high rating. Make sure it works for your needs:

• Are your doctors in-network?
• Are your medications covered on the formulary?
• What are the copays and out-of-pocket costs?
• Does the plan include extra benefits you need (dental, vision, etc.)?

Step 4: Verify the rating is current. Star ratings change every year. A plan that was 5 stars last year might not be 5 stars this year. Check the current rating before you switch.

If you find a 5-star plan that fits your needs, you can enroll during the 5-Star Special Enrollment Period.

When You Should Consider Switching to a 5-Star Plan

Switching to a 5-star Medicare Advantage plan makes sense if:

Your current plan has a low star rating (3 stars or below). Low-rated plans consistently deliver poor experiences. If your plan is rated 3 stars or lower, that’s a red flag.

You’re dealing with frequent billing issues or denied claims. If you’re constantly fighting with your insurance company, a higher-rated plan will likely give you a better experience.

Your doctors are leaving the network. If your plan keeps losing doctors or hospitals, that’s a sign of instability. A 5-star plan is more likely to have stable networks and better provider relationships.

You’re paying more than you expected. Low-rated plans often have hidden costs — higher copays, stricter prior authorization requirements, and unexpected out-of-pocket expenses. Five-star plans tend to be more transparent.

You’re frustrated with customer service. If you can’t get answers when you need them, or if the plan makes it hard to appeal denials, a 5-star plan will likely be more responsive.

But here’s the thing: a 5-star rating doesn’t automatically mean the plan is the best fit for you. You still need to check networks, drug coverage, and costs.

A 5-star plan that doesn’t cover your doctors or medications isn’t better than a 4-star plan that does.

For more on comparing plans, read Original Medicare vs. Medicare Advantage: What’s the Difference and Medicare Advantage vs. Medigap: Which Saves You More?

What If There’s No 5-Star Plan in Your Area?

Not every county has a 5-star Medicare Advantage plan. If there isn’t one available where you live, you have other options.

Look for 4-star plans. Four-star plans also deliver high-quality care and good member experiences. They may not qualify for the 5-Star Special Enrollment Period, but they’re still solid choices.

Switch during the Annual Enrollment Period. From October 15 to December 7 every year, you can switch Medicare Advantage plans regardless of star ratings. Compare your options and choose the best plan available in your area.

Consider returning to Original Medicare with Medigap. If you’re unhappy with Medicare Advantage and you qualify for guaranteed-issue rights, you can switch back to Original Medicare and add a Medigap plan. This gives you nationwide access to doctors without networks or prior authorizations.

For more on switching plans, read How to Switch Medicare Advantage Plans.

Common Mistakes People Make With Star Ratings

Here are the mistakes I see most often:

Assuming a 5-star rating means the plan is perfect. A high rating means the plan performs well overall. But it doesn’t mean it’s the right plan for your specific needs. Always check networks, drugs, and costs.

Ignoring star ratings entirely. Many people choose plans based only on premiums. That’s a mistake. Star ratings give you insight into quality and service that premiums don’t reveal.

Not checking star ratings every year. Ratings change. A plan that was 5 stars last year might drop to 4 or 3 stars this year. Check the current rating during the Annual Enrollment Period.

Not using the 5-Star Special Enrollment Period. If you’re stuck in a low-rated plan and there’s a 5-star option nearby, use the Special Enrollment Period to switch. Don’t wait until fall if you don’t have to.

Frequently Asked Questions

Where can I find my plan’s star rating?
Go to Medicare.gov and use the Plan Finder tool. Enter your zip code and search for your plan. The star rating will be displayed.

Do star ratings apply to Medigap plans?
No. Star ratings only apply to Medicare Advantage and Part D plans. Medigap plans are standardized, so they don’t receive star ratings.

Can I switch to a 5-star plan during the Annual Enrollment Period?
Yes. You can switch to any plan (regardless of star rating) during the Annual Enrollment Period (October 15 – December 7).

What happens if my 5-star plan drops to 4 stars?
You can stay in the plan. Your coverage doesn’t change just because the rating changes. But you should review the plan during the next Annual Enrollment Period to see if there’s a better option.

Are 5-star plans more expensive?
Not necessarily. Many 5-star plans have competitive premiums. Some even have $0 premiums. The premium doesn’t always correlate with the star rating.

The Bottom Line: Use Star Ratings to Find Better Coverage

Medicare Advantage star ratings give you a way to evaluate plans based on quality, not just price.

Plans with 4 or 5 stars consistently deliver better service, better member experiences, and better health outcomes. Plans with 2 or 3 stars often leave members frustrated.

And if there’s a 5-star plan in your area, you can switch to it almost any time of year using the 5-Star Special Enrollment Period.

Don’t ignore star ratings. Don’t assume all plans are the same. And don’t stay stuck in a low-rated plan just because it’s easier than switching.

Check your plan’s rating. Compare your options. And make sure you’re getting the quality and service you deserve.

Need Help Choosing a Medicare Advantage Plan?

If you’re not sure how to compare plans or whether a 5-star plan is right for you, let’s talk.

We’ll walk through your situation, check the star ratings in your area, and help you find a plan that fits your needs — without the confusion or pressure.

You can also scan the QR code to fill out your medications, doctors, and pharmacy information ahead of time. That way, we can waive the 48-hour rule and get you answers faster.

Next step is simple: Book your free consultation, or reach out with questions. We’re here to help.