Medicare 5 Star Ratings:  Why is it important?

Medicare is a federal health insurance program that provides coverage for people turning 65 and older, as well as some younger people with disabilities. With a variety of plans and options available, it can be challenging to choose the right one. This is where Medicare 5 Star Ratings come in. 

What is Medicare 5-Star Ratings?

Medicare came up with the Star Rating system to give people with Medicare a fair measure of a plan’s performance. The rating system enables people to weigh things based on quality and cost to make sound enrollment decisions. Medicare Advantage Plans and Medicare Prescription Drug Plans are being evaluated, and the scores scale from 1 to 5 – with 5 stars being the highest. 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.

Medicare 5 Star RatingsAs people shop for a Medicare plan, they look closely at the benefits offered and how much it would cost. However, when looking at options for plans with similar coverage and pretty much the same in cost, it is better to look closely at the star rating. Data and numbers don’t lie, and star ratings tell you the plan’s performance, and many are satisfied with it. The high rating means quality plans or services are offered, undeniably.

Why are Medicare 5 Star Ratings important?

Medicare 5 Star Ratings provide an objective and standardized evaluation of the quality of care provided by Medicare plans. These reviews cover a wide range of factors, including access to care, customer service, and patient outcomes.

Here are some reasons why Medicare 5 Star Reviews are essential:

  1. They help you make informed decisions about your healthcare: By reading Medicare 5 Star Reviews, you can get a better understanding of the quality of care provided by different Medicare plans. This can help you choose a plan that meets your healthcare needs and budget.

  2. They provide an objective evaluation of Medicare plans: Medicare 5 Star Reviews are conducted by an independent organization, which means they are unbiased and objective. This ensures that the information provided is reliable and trustworthy.

  3. They encourage Medicare plans to provide high-quality care: Medicare 5 Star Reviews are an incentive for Medicare plans to provide high-quality care. Plans that receive higher ratings are more likely to attract new members and retain existing ones.

How can Medicare 5 Star Ratings help you choose the right plan?

Medicare 5 Star Reviews can be a valuable tool in helping you choose the right Medicare plan for your healthcare needs. Here are some ways they can help:

  1. They can help you compare different plans: Medicare 5 Star Reviews allow you to compare different plans based on factors such as customer service, access to care, and patient outcomes. This can help you identify the plan that is best suited to your needs.

  2. They can help you avoid low-quality plans: Medicare 5 Star Reviews can help you avoid plans that provide low-quality care. Plans with low ratings may have a higher incidence of medical errors, longer wait times, or other issues that can negatively impact your health.

  3. They can help you save money: Medicare 5 Star Reviews can help you choose a plan that provides high-quality care while also being cost-effective. Plans with higher ratings may offer better benefits or lower out-of-pocket costs.

How health plans are rated

Each fall, Medicare evaluates the performance of plans and issues new star ratings on a yearly basis, which means that a plan’s rating may vary from one year to the next.

The rating system for Medicare Advantage Plans assesses their performance across five different categories:

  1. Staying healthy: screenings, tests, and vaccines
  2. Managing chronic (long-term) conditions
  3. Plan responsiveness and care
  4. Member complaints, problems getting services, and choosing to leave the plan
  5. Health plan customer service

Part D plans are rated on how well they perform in four different categories:

  1. Drug plan customer service
  2. Member complaints, problems getting services, and choosing to leave the plan
  3. Member experience with the drug plan
  4. Drug pricing and patient safety

It’s important to keep in mind that the star rating alone is not sufficient when selecting a plan. You should also ensure that the plan’s coverage and costs align with your specific needs. For instance, if you are considering a Part D plan, it’s crucial to verify that the plan covers your required drugs at a cost that is affordable for you.

Where can I find information on my plan’s star rating?

Star ratings can be found using Medicare’s Plan Finder tool or by calling 1-800-MEDICARE. New plan quality ratings come out each October and apply to the next calendar year (for example, plan ratings for 2021 will be available in October 2020). Note: Star ratings in the Medicare & You handbook may be outdated. For up-to-date information on star ratings, check Plan Finder or call 1-800-MEDICARE.

How can I use the star ratings to inform my plan choice this year?

To make an informed decision about your plan selection this year, you can leverage star ratings to compare plans in your service area based on the categories listed above, which Medicare considers to be critical performance indicators for a plan. It’s essential to remember that a plan’s star rating is just one of several factors to consider when comparing plans. Even if a plan has a high star rating, it may not be the right option for you. You should also take into account the plan’s coverage, costs, and network of providers and pharmacies.

If a plan receives a rating of fewer than three stars for three years in a row, Plan Finder will label it as low-performing. The symbol used by Plan Finder to indicate a low-performing plan is an upside-down red triangle with an exclamation point inside it (similar to a caution sign). Medicare will notify you if the plan you are enrolled in has been flagged as low-performing. Although you will not be removed from the plan, you should check its costs and coverage to ensure it is still a viable option for you.

What does the five-star Special Enrollment Period (SEP) mean?

Under normal circumstances, changing plans or enrolling in a new plan can only be done during specific enrollment periods. Special Enrollment Periods (SEPs) are periods outside of regular enrollment periods that are triggered by specific circumstances. The five-star SEP allows you to join or switch to a Medicare Advantage or Part D plan with an overall plan performance rating of five stars. You can use this SEP once per calendar year.

This SEP starts on December 8 of the year before the plan is considered a five-star plan (keep in mind that ratings are released in October) and ends on November 30 of the year the plan becomes a five-star plan. If you enroll in December, the plan’s effective date is January 1. If you enroll from January to November, the effective date is the month after the enrollment request is made.


Q: What is the highest rating a Medicare plan can receive?

A: The highest rating a Medicare plan can receive is 5 stars.

Q: Are all Medicare plans rated?

A: No, not all Medicare plans are rated. Only plans that provide medical and prescription drug coverage are rated.

Q: Can Medicare 5 Star Reviews be trusted?

A: Yes, Medicare 5 Star Reviews are conducted by an independent organization and are based on objective criteria. This ensures that the information provided is reliable and trustworthy.


Medicare 5 Star Reviews are an essential tool in helping seniors make informed decisions about their healthcare. These reviews provide valuable insights into the quality of care provided by Medicare plans, helping seniors choose a plan that meets their healthcare needs and budget. By using Medicare 5 Star Reviews to compare plans, seniors can avoid low-quality plans, save money, and ensure they receive high-quality care.

Need help? Call Health Plans in Oregon: 503-928-6918. Our assistance is at no cost to you.

*By completing this form, you agree that an authorized representative or licensed insurance agent may contact you by phone,email,text, mail or face to face to answer your questions or provide additional information about your Medicare plan options. Not affiliated or endorsed by Medicare or any state or federal governmental agency.

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