Medicare Advantage Star Ratings: What They Mean and Why They Matter

What Are Medicare Advantage Star Ratings?

Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates every Medicare Advantage plan and Part D prescription drug plan in the country and assigns each one a quality rating on a scale of one to five stars. One star is the worst. Five stars is the best. These ratings are not cosmetic labels or marketing tools — they are backed by measurable data and carry real financial consequences for insurance companies and real enrollment benefits for you.

CMS created the star rating system to give Medicare beneficiaries a straightforward way to compare plan quality. Before star ratings, it was nearly impossible for the average person to tell whether their plan was actually delivering good care or just offering a low premium. The star system changed that by distilling dozens of quality measures into a single, easy-to-understand score.

Here is what each star level means at a glance:

• 5 stars: Excellent performance across nearly all measures
• 4 stars: Above average — solid quality with room for minor improvement
• 3 stars: Average performance — meets minimum standards but nothing more
• 2 stars: Below average — CMS may flag these plans for improvement
• 1 star: Poor performance — plans risk being terminated from the Medicare program

For the 2026 plan year, approximately 74% of Medicare Advantage enrollees are in plans rated 4 stars or higher. That percentage has grown steadily over the past decade as insurers have invested heavily in improving their ratings — and as lower-rated plans have been pushed out of the market.

What Star Ratings Actually Measure

Star ratings are not based on a single survey or a single data point. CMS evaluates plans across approximately 40 individual quality measures that fall into five broad categories. Understanding these categories helps you interpret what a high or low rating actually reflects about your day-to-day experience with a plan.

1. Staying healthy: screenings and preventive care

This category measures how well a plan encourages and delivers preventive care. CMS looks at rates of cancer screenings (breast, colorectal), annual flu vaccinations, and other wellness services. A plan that scores well here is proactively keeping its members healthy rather than just treating illness after it appears.

2. Managing chronic conditions

For members with ongoing health conditions like diabetes, heart disease, or high blood pressure, CMS evaluates how effectively the plan helps manage those conditions. This includes measures like whether diabetic members are getting regular blood sugar testing, whether blood pressure is being controlled, and whether members with heart conditions are receiving appropriate medications. If you have a chronic condition, this category may be the most important one to pay attention to when comparing Medicare Advantage plans.

3. Member experience and satisfaction

CMS uses data from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, which goes directly to plan members. The survey asks about overall satisfaction with the plan, ease of getting appointments, coordination of care, and whether members feel their doctors communicate well. This is the one category that reflects the actual lived experience of people enrolled in the plan — not just clinical data points.

4. Member complaints and customer service

This category tracks how many complaints CMS receives about a plan, how quickly the plan resolves appeals and grievances, and how often members choose to leave the plan. A high complaint rate or a high disenrollment rate is a red flag. CMS also evaluates how well the plan's customer service handles inquiries — including call center responsiveness and the accuracy of information provided.

5. Drug plan performance (Part D)

For Medicare Advantage plans that include prescription drug coverage (MA-PD plans), CMS evaluates the drug benefit separately. This includes measures like how competitively the plan prices common medications, whether members can get their prescriptions filled without unnecessary delays, medication adherence rates, and patient safety indicators such as avoiding potentially dangerous drug interactions. Since most Medicare Advantage plans bundle Part D coverage, this category affects the vast majority of plans.

How CMS Calculates Star Ratings

The calculation process is more rigorous than most people realize. CMS does not simply average the five categories and call it a day. Each of the roughly 40 individual measures is scored on a 1-to-5 scale, and then those scores are combined using a weighted formula. Some measures count more than others.

CMS assigns each measure a weight of 1, 1.5, or 3. The highest-weighted measures — the ones that count triple — are called "improvement measures" and "patient outcome measures." These are the metrics CMS considers most indicative of actual plan quality. For example, whether a plan is improving its performance year over year gets triple weight, which means a plan cannot coast on past results.

Here is the general process CMS follows each year:

• Data collection: CMS gathers clinical data, member survey responses, complaint records, and drug plan performance data from the prior year
• Measure scoring: Each individual measure is scored on a 1-to-5 scale based on established thresholds
• Weighted averaging: Scores are combined using the weighted formula, with improvement and outcome measures receiving triple weight
• Overall star assignment: The final weighted average is rounded to the nearest half-star to produce the plan's overall star rating
• Publication: CMS publishes ratings every October, ahead of the Annual Election Period that runs from October 15 through December 7

One critical detail: the data used for star ratings is typically 12 to 24 months old by the time ratings are published. The 2026 star ratings, for example, are based primarily on plan performance data from 2024. This means ratings reflect a plan's recent track record, not necessarily its current operations — though CMS argues that plan quality tends to be consistent over time.

Why 4+ Star Plans Matter: Bonus Payments and Year-Round Enrollment

Star ratings are not just informational — they have major financial consequences that directly affect your benefits. The most significant impact is the quality bonus payment system. Plans rated 4 stars or higher receive bonus payments from CMS, typically an additional 5% of their base benchmark payment. These bonuses amount to billions of dollars industry-wide.

What happens with that bonus money matters to you as an enrollee. CMS requires that at least a portion of bonus payments be reinvested into the plan. In practice, most insurers use the extra funding to offer richer benefits — lower copays, expanded dental and vision coverage, reduced or eliminated premiums, over-the-counter allowances, fitness benefits, and transportation services. This is a major reason why highly rated plans tend to offer more generous benefits than their lower-rated competitors.

There is also a direct enrollment benefit. If a plan earns a full 5-star rating, its members gain access to a 5-Star Special Enrollment Period (SEP). This means anyone eligible for Medicare can enroll in that 5-star plan at any time during the year — not just during the Annual Election Period. This is a powerful competitive advantage for the plan and a valuable option for beneficiaries who missed other enrollment windows or who want to switch away from a lower-quality plan mid-year.

Conversely, plans that receive low ratings face penalties. Plans rated below 3 stars for three consecutive years may be terminated from the Medicare program entirely. CMS can also restrict enrollment for low-performing plans, preventing them from accepting new members until their quality improves. This creates a strong market incentive for insurers to maintain high ratings.

How to Check Your Plan's Star Rating

Checking star ratings is straightforward, and CMS provides several ways to do it. The most user-friendly option is the Medicare Plan Finder tool at Medicare.gov. Here is how to use it:

• Go to Medicare.gov/plan-compare
• Enter your ZIP code to see all available plans in your area
• Each plan listing displays its overall star rating prominently
• Click into any plan to see individual category ratings — not just the overall score
• Use the comparison feature to view up to three plans side by side

You can also call 1-800-MEDICARE (1-800-633-4227) and ask a representative to look up your plan's rating. Your plan is also required to disclose its star rating in its Annual Notice of Change (ANOC), which it must send you every September before the Annual Election Period opens. Beyond the overall rating, it is worth looking at the category-level breakdown. A plan might have a strong overall rating of 4 stars but score poorly on member complaints or drug plan performance — two areas that could directly affect your experience. Compare plans not just by overall score but by the categories that matter most to you when evaluating the best Medicare Advantage plans available in your area.

2026 Star Rating Changes and Trends

The 2026 star ratings, released in October 2025, brought several notable shifts that beneficiaries should understand. CMS has been progressively tightening its methodology, and 2026 ratings reflect some of those changes.

Increased weight on health equity. CMS has introduced a Health Equity Index (HEI) reward that gives additional credit to plans demonstrating strong performance among enrollees with social risk factors such as low income, disability, or dual eligibility for Medicare and Medicaid. This is part of a broader push to ensure that star ratings reflect how well plans serve their most vulnerable members, not just their healthiest ones.

Tighter cut points for high ratings. CMS periodically adjusts the performance thresholds — called cut points — required to earn each star level. As the industry average improves, the bar rises. Some plans that earned 4 stars in 2025 may have slipped to 3.5 stars in 2026 even if their actual performance did not decline, simply because the cut points moved upward.

CAHPS survey methodology updates. The member experience survey has been updated to better capture patient experiences with telehealth, care coordination, and behavioral health access — reflecting the post-pandemic reality of how care is delivered. Plans that invested in telehealth infrastructure and mental health networks may see rating improvements.

Fewer 5-star plans. The 2026 ratings saw a slight decrease in the number of plans achieving a perfect 5-star rating. This is consistent with CMS's stated goal of making 5 stars genuinely exceptional rather than common. As the methodology becomes more demanding, a 5-star rating becomes a stronger signal of truly outstanding quality.

For 2026, the average star rating across all Medicare Advantage plans is approximately 4.14 stars. That sounds high, but remember that it is enrollment-weighted — larger, better-funded plans tend to earn higher ratings, and they also have the most enrollees. If you look at the raw count of plans rather than enrollment, a significant number of smaller or regional plans still fall below 4 stars. It is a reminder that understanding the different parts of Medicare and how quality is measured can help you make a more informed choice.

Limitations of Star Ratings: What They Do Not Tell You

Star ratings are a valuable tool, but they are not the complete picture. There are meaningful limitations you should be aware of before relying on them as your sole decision-making factor.

• Ratings are contract-level, not plan-level. An insurer may operate multiple plans under a single contract. All plans under that contract share the same star rating, even if individual plan benefits, networks, or service areas differ significantly.
• They do not measure network size. A plan can earn 5 stars with a narrow network. Star ratings do not evaluate how many doctors or hospitals are in the plan's network — only the quality of care delivered within that network.
• They do not account for cost. Two plans might both be rated 4 stars, but one charges a $50 monthly premium with $40 specialist copays while the other has a $0 premium with $20 copays. The rating does not capture these cost differences.
• Data lag. As noted, ratings are based on data that is one to two years old. A plan could have changed ownership, restructured its network, or altered its benefits since the data was collected.

None of this means star ratings are not useful — they absolutely are. But they should be one input in your decision, not the only one. Combine star ratings with a review of the plan's specific network, formulary, costs, and coverage details.

How to Use Star Ratings When Choosing a Plan

Here is a practical framework for incorporating star ratings into your Medicare Advantage plan decision. Whether you are enrolling for the first time or evaluating your current plan during the Annual Election Period, these steps will help you use ratings effectively.

• Start with 4+ star plans. Use the Medicare Plan Finder to filter by plans rated 4 stars or higher in your area. These plans receive bonus funding, which typically translates to better benefits for you.
• Check the category breakdown. If you take multiple medications, prioritize plans with high drug plan performance scores. If you have chronic conditions, focus on managing-chronic-conditions scores. Tailor your evaluation to your personal health profile.
• Verify your doctors are in-network. A 5-star plan is worthless to you if your primary care physician and specialists are not in the network. Always confirm provider participation before enrolling.
• Review the formulary. Make sure your prescriptions are covered and check which tier they are on. A plan with great star ratings but poor formulary coverage for your medications could still cost you more overall.
• Compare total costs, not just premiums. Factor in premiums, deductibles, copays, coinsurance, and the out-of-pocket maximum. The lowest-premium plan is not always the least expensive plan when you account for what you actually use.

If you are currently enrolled in a plan whose star rating has dropped, that is a signal to seriously evaluate your options. A declining rating may indicate that the plan's network, customer service, or clinical quality is weakening — and those issues could affect you directly. You can learn more about the differences between Medicare Advantage and Original Medicare to understand all your coverage options.

Frequently Asked Questions About Medicare Star Ratings

What is a good star rating for a Medicare Advantage plan?

A rating of 4 stars or higher is generally considered good. Plans at this level receive quality bonus payments from CMS, which typically translate to richer benefits for members. A 5-star rating represents the highest level of quality. Most experts recommend avoiding plans rated below 3 stars unless there is a compelling reason, such as a uniquely strong provider network in your area.

How often are star ratings updated?

CMS updates star ratings once per year. New ratings are published every October, just before the Annual Election Period begins on October 15. The ratings are based on data collected over the prior one to two years. This annual cycle gives you fresh information to review before making enrollment decisions for the following plan year.

Can I switch to a 5-star plan at any time?

Yes. CMS offers a 5-Star Special Enrollment Period that allows any Medicare-eligible person to enroll in a 5-star Medicare Advantage or Part D plan at any time during the year. You are not limited to the Annual Election Period. You can use this SEP once per calendar year. This is one of the most tangible benefits of the star rating system for consumers.

Do star ratings affect my premiums?

Not directly, but indirectly yes. Plans with 4 or more stars receive bonus payments from CMS, and much of that bonus funding is used to reduce member premiums, lower copays, or add benefits like dental and vision. This is why many 4- and 5-star plans are able to offer $0 premiums while still providing comprehensive coverage. Lower-rated plans without bonus funding often have to charge higher premiums or offer fewer extra benefits.

What happens to plans with very low star ratings?

Plans rated below 3 stars for three consecutive years can face serious consequences. CMS may restrict the plan from enrolling new members, require the plan to submit a corrective action plan, or ultimately terminate the plan's Medicare contract. If your plan is terminated, you will receive notice and be given a special enrollment period to choose a new plan. CMS takes persistently low performance seriously — it is one of the primary enforcement mechanisms for plan quality.

Are star ratings the same for Medicare Advantage and standalone Part D plans?

The rating system is similar but not identical. Standalone Part D plans are rated on drug-specific measures only, such as drug pricing, patient safety, and member experience with the drug plan. Medicare Advantage plans that include drug coverage (MA-PD plans) are rated on both the health plan and drug plan measures combined into one overall rating. If you are enrolled in Original Medicare with a standalone Part D plan, you will see a separate star rating for just the drug plan.

Where can I find historical star ratings for my plan?

CMS publishes historical star rating data on its website at cms.gov. You can download datasets going back several years to see how a plan's rating has trended over time. A plan that has consistently maintained 4 or more stars over multiple years is a stronger bet than one that just jumped to 4 stars for the first time. Consistent high ratings indicate stable operational quality, while fluctuating ratings may suggest underlying management or network issues.

The Bottom Line

Medicare Advantage star ratings are one of the most useful tools available to Medicare beneficiaries. They condense complex quality data into a simple, comparable score that reflects how well a plan delivers care, manages chronic conditions, serves its members, and administers drug benefits. Plans rated 4 stars or higher receive bonus funding that translates to better benefits for you, and 5-star plans offer the added advantage of year-round enrollment.

But star ratings are not the whole story. Always verify that your doctors are in the plan's network, confirm your medications are on the formulary, and compare total costs — not just premiums. A 4-star plan where your doctors participate and your drugs are covered at a reasonable tier will almost always serve you better than a 5-star plan where you have to switch providers or pay more for your prescriptions.

Use the Medicare Plan Finder at Medicare.gov every fall when new ratings are released. Check your current plan's rating, compare alternatives, and make sure you are getting the quality of care you deserve. The star rating system exists to empower you with information — take advantage of it.