What Is the 5-Star Rating for Medicare Advantage Plans?

Medicare Advantage Plans are contracted with the government to provide health services to Medicare beneficiaries, and these plans receive payments from the government to help cover the cost of care. They are also called Medicare Part C and do not require medical underwriting to get the plan. These plans are rated up to Five Stars that measure their effectiveness in addressing their members’ health concerns. Four and Five-Star rated plans indicate a high level of efficacy in evaluating and rectifying health issues.

The Centers for Medicare and Medicaid rate the plans using a list of measures, including issues like management of chronic disease, member experience, complaints, health maintenance, and customer service. The list of measures is updated annually by CMS so that improved methodology can be applied to more effectively gauge the success of individual plans. Plans that score high can get an additional quality bonus from the government.

Most Advantage Plans include prescription drug coverage or Medicare Part D in their coverage. Part D coverage is rated separately and may be different from the overall plan rating. Part D includes parameters that measure drug pricing and patient safety. A plan may have an overall rating of 5 Stars but a Part D rating of 4 Stars so the rating of the plan would be 4.5 Stars.

Use the rating system as a helpful guide when evaluating Medicare Advantage plans. Also, make sure the doctors you want to see are in network, and check the plan’s formulary to see that your prescription medications are covered.