What are star ratings?

The Centers for Medicare and Medicaid Services (CMS) created a five star rating system to measure the quality and performance of Medicare Advantage and prescription drug plans. Ratings range from 1 to 5 stars, with five being the highest and one being the lowest. Ratings are based on the following five categories:

1. Staying healthy: screenings, tests and vaccines.
   How well the plan works to detect and prevent illness. Also rates how well the plan improves and maintains physical and mental health of its members (e.g., whether members get screening tests, vaccines and other check-ups to help them stay healthy).


2. Managing chronic (long-term) conditions.
   How well plans help members with chronic or long-lasting health conditions. (e.g., are members getting recommended care and how often are they readmitted to the hospital).


3. Member experience with the health plan.
   How well the plan performed on Medicare’s member experience survey (the ease of getting appointments and care, information, coordination of the members’ health care services, members’ overall ratings of the plan).


4. Member complaints, problems getting services, and choosing to leave the plan.
   How often members have problems with the plan, how often members leave the plan, and how much the plan’s performance has improved (if at all) over time.


5. Health plan customer service.
   How the plan performs in customer service areas (how quickly and how well the plan handles member appeals).

For plans covering prescription drugs, this is an overall rating for the quality of prescription-related services that fall into the following four 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.

In the fall of each year, Medicare reviews a plan’s performance and releases new star ratings. Therefore, our star ratings may change from year to year.