If you’ve been researching Medicare Advantage plans, you’ve probably seen star ratings associated with each plan.
But what do these stars mean, and how can they help you choose the best plan for you? This blog post will break it down, so you can understand the star ratings, how they work, and how we use them to help you select the best Medicare Advantage plan available.
First, let’s review the basics.
What is Medicare Advantage?
Medicare Advantage is a popular alternative to Original Medicare offered by private insurance companies.
It’s also called Medicare Part C.
Some of the key features of Medicare Advantage plans include:
- All the benefits of Medicare Parts A and B combined into a single plan.
- Built-in Medicare Part D prescription drug benefits for most but not all Medicare Advantage Plans
- Supplemental benefits (with some plans) like dental, vision, and hearing coverage not available under Original Medicare
- Low premiums (many plans have a zero premium), making them very affordable month-to-month
- Limited care networks.
- Relatively high potential out-of-pocket costs in the event you need care
Your monthly premiums, if any, will vary by plan and location. Medicare Advantage Plans are regulated by Medicare and must meet specific standards.
While these ratings offer insights into plan quality, they shouldn’t be the sole factor in choosing a plan. This guide explains what the ratings mean, how to use them effectively, and other important considerations for selecting healthcare coverage.
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What Are Medicare Star Ratings?
To help beneficiaries compare Medicare Advantage plans the Centers for Medicare & Medicaid Services (CMS) provides a five-star rating system.
Every Medicare Advantage plan is rated on a five-star scale
- 5 Stars: Excellent quality
- 4 Stars: Above-average quality
- 3 Stars: Average quality
- 2 Stars: Below-average quality
- 1 Star: Poor quality
Ratings are updated every year in October.
How Are Medicare Star Ratings Determined?
The CMS star rating system evaluates several aspects of a plan’s performance to determine its overall quality.
Here are the key categories:
- Preventive care services. Plans are rated based on customer access to preventive services such as screenings, vaccines, and wellness visits. Higher scores indicate a strong emphasis on preventive care.
- Chronic Conditions Management. This measures the plan’s effectiveness in helping members with chronic health issues. The focus is on treatment availability and monitoring practices.
- Member Experience. Surveys plan members on satisfaction with care quality and access. High satisfaction scores reflect dependable and accessible services.
- Plan Responsiveness. This rating looks at how quickly members can get appointments and the efficiency of care delivery.
- Complaints and Disenrollment. This rating monitors the frequency of complaints and plan drop-outs. Fewer complaints and fewer cancellations or dropouts mean a higher star rating.
- Customer Service. Evaluates the plan’s ability to handle member issues and provide helpful support.
Beyond Star Ratings: Important Considerations
While star ratings provide valuable insights, they aren’t the only consideration.
You should also go into detail and look at the specifics of your plan, as well as your own budget, medical history, and circumstances. Just because a plan has a high star rating doesn’t mean it’s the best plan for you.
Our MediGap Advisors Personal Benefits Managers are here to help you analyze all these other important criteria:
- Provider Networks. Confirm that your preferred doctors, hospitals, and pharmacies are included in the plan. A highly rated plan may not work if it lacks your providers, causing extra costs or requiring a provider switch.
- Supplemental coverage. Some plans provide coverage for prescription drugs, vision care, dental, and hearing. Some don’t or provide only very limited benefits.
Some plans also provide coverage for things like personal assistant visits, nutritional programs, medically necessary home modifications, and non-medical transportation benefits.
Medicare Advantage plans are constantly striving to differentiate themselves from competitors. They therefore roll out new and innovative benefits each year. . - Costs. Star ratings don’t factor in plan costs. You should look carefully not just at premiums, but also at deductibles, copays, and maximum out-of-pocket costs (MOOP). A plan that has very low or no premium may have higher costs on the “back end,” if you need medical care.
- Special Needs Plans (SNPs). These are special plans, pronounced “snips”, are optimized for people with particular healthcare needs. Examples include people with diabetes or end-stage renal failure.
If you have a chronic medical condition, a SNP focused on your condition may be the best match for you, even if it doesn’t have the highest star rating.
Alternatives to Medicare Advantage
If Medicare Advantage doesn’t meet your needs, consider other options:
- Original Medicare with Medigap. While Original Medicare alone may be limited, adding a Medigap (supplemental) policy can provide greater flexibility and access to a broader range of providers.
- Medi-Share 65+. This is an increasingly popular and affordable noninsurance alternative to Medigap.
It’s a Christian health sharing plan. It limits your out-of-pocket costs for everything approved but not paid under Medicare Parts A and B to $500 per household per year.
Monthly costs are much lower than similarly comprehensive Medigap plans like G, D, and N. And like Medigap plans, Medi-Share 65+ doesn’t have narrow care networks. You can use your plan with any provider.
Neither Medigap plans nor Medi-Share 65+ include prescription drug coverage by themselves. Most people who opt for one of these alternatives buy a separate Part D plan.
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Conclusion: Making the Most of Medicare Star Ratings
Medicare Advantage star ratings are a powerful tool to help you compare plans, but they are just one piece of the puzzle.
While a high star rating is helpful, it’s important to evaluate plans based on your needs, including networks, benefits, and total costs. Remember, the “best” plan is the one that fits your healthcare needs, lifestyle, and budget—not just the one with the highest rating.
If you’re feeling overwhelmed or uncertain about your choices, you don’t have to navigate this alone. Our MediGap Advisors Personal Benefits Managers are here to provide expert guidance tailored to your situation. Whether you’re comparing star-rated plans, exploring alternatives like Medigap or Medi-Share 65+, or looking for help with enrollment, we’re ready to assist.
Contact us today for a free consultation and take the next step toward securing the coverage that works best for you. Your health is too important to leave to chance—let us help you make an informed decision with confidence.
For Further Reading
Tom Lockwood is a Personal Benefits Manager at MediGap Advisors. Tom has a passion for bringing clarity to those confused about Medicare. He is an authority on Medicare, Medicare supplement plans, Medicare Advantage plans, and Part D prescription drug plans. Read more about Tom on his Bio page.