While Medicare Advantage plans offer more benefits and coverage than Original Medicare, the service you receive can vary from plan to plan.
The best performing Medicare Advantage plans are ones that receive a Five-Star rating in the annual Star Ratings Report. These Medicare plans provide their members with excellent service, performance, and benefits.
This guide will tell you all about Five-Star rated plans and how you can find the best Five-Star Medicare Advantage or Prescription Drug coverage in your area.
The federal Medicare program is a health scheme administered by the federal government for people over the age of 65. It also covers people of any age with ESRD, ALS (Lou Gehrig’s), or those who receive Social Security Disability Insurance.
Once you enroll in Medicare, there are different coverage options you can get:
Original Medicare: This is government-administered insurance coverage for inpatient and outpatient medical expenses.
Medicare Supplement Insurance plans: These are plans that cover the costs Medicare doesn’t pay for. They are available to people with Original Medicare.
Medicare Part D coverage: These are plans that help members pay for the cost of self-administered prescription medication.
Medicare Advantage plans: These are private health insurance policies that offer the same coverage as Original Medicare, along with additional benefits.
The Centers for Medicare and Medicaid Services (CMS) reviews private insurance companies, Prescription Drug Plans, and Medicare Advantage plans each year in October.
This review uses a star rating to give Medicare beneficiaries a simple overview of the performance and quality of services provided.
The Medicare Star Rating System covers:
✅ Medicare Advantage plan with Prescription Coverage
✅ Medicare Advantage plan without Prescription Coverage
✅ Prescription Drug Plans (Part D Plans)
✅ Health Insurance Companies that offer Medicare Plans
❌ Medicare Supplement Insurance
A plan can get a maximum rating of five stars and a minimum of one star. Star ratings go up by halves, meaning a plan can score 3.5 stars or 4.5 stars. The Medicare Star Rating System also provides a number value for each star rating.
For example, a plan might have 3.5 stars and receive a numerical rating of 3.56. Or a plan might be rated as a 4-star plan, but its numerical score is 4.05.
⭐: Poor Performance
⭐⭐: Below Average Performance
⭐⭐⭐: Average Performance
⭐⭐⭐⭐: Good Performance
⭐⭐⭐⭐⭐: Excellent Performance
The CMS also carefully monitors plans and health insurance providers with the Medicare Star Rating system.
For example, if a plan or provider gets a score lower than three stars for three years it is considered low performing. The CMS will flag it, notify members of the plan’s status, and remove it from the online Medicare-finder portal.
Before you use the Medicare Star Rating System to review your plan, keep these points in mind:
Plan and provider performance will vary across counties and ZIP codes. A health insurance provider might have the same plan type in ten different locations, but each will receive a separate Medicare star rating.
Many health insurance companies have state-focused divisions, which are scored separately. While the brand might be the same in different states, each company will receive a unique Medicare star rating.
Medicare Star Ratings change every year. A Medicare Advantage plan rated as three stars in one year might receive a higher score the following year.
This means it’s essential that you check your specific Medicare Advantage plan, Prescription Drug Plan, and company’s performance before deciding on your health coverage.
A Medicare Advantage plan, Prescription Drug Plan, or health insurance company that receives the highest score on the Medicare Star Rating scale is considered a Five-Star plan or provider.
If a Medicare Advantage plan or Prescription Drug Plan receives a Five-Star rating, this means that it:
Makes significant improvements to its member’s physical health.
Actively assists in improving the health status of its beneficiaries.
Has little to no barriers that stop members from receiving care.
Provides comprehensive services that assist its beneficiaries in maintaining, monitoring, and improving their health.
Is rated highly by its members.
If a Medicare Advantage plan or Prescription Drug Plan has received a five-star rating, it will receive a high-performing icon next to its name.
Here’s what it looks like:
In 2021, the CMS rated that 87 MA-PD, PDP, and MA-only plans received a high-performing icon for the upcoming year. Here’s a more detailed breakdown:
|Type of Plan||Number of Plans that Received the High-performing Icon|
|MA-PDs (Medicare Advantage plan with Prescription Drug Cover)||74 plans|
|MA-only (Medicare Advantage plan without Prescription Drug Cover)||3 plans|
|PDPs (Prescription Drug Plans)||10 plans|
The Centers for Medicare and Medicaid Services (CMS) rates Five-Star Medicare plans according to different measures of performance.
Health care policies and providers need to score well in the following categories to be rated as high-performing plans. For Medicare Advantage plans there are five measures:
Staying Healthy: Screenings, Tests, and Vaccines
Managing Chronic (Long-Term) Conditions
Member Experience with Health Plan
Member Complaints and Changes in the Health Plan’s Performance
Health Insurance Plan Customer Service
For Prescription Drug Plans there are four measures:
Drug Plan Customer Service
Member Complaints and Changes in the Health Plan’s Performance
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing
Because they cover both MA and prescription drugs, MA-PD plans are rated on all nine of the measures listed above.
PDPs: Prescription Drug Plans or Part D drug plans help their members pay for drugs and medication costs.
MA plans: Offer coverage for Part A and Part B expenses. While they do offer additional health benefits, they do not cover Part D expenses.
MA-PD plans: Offer Part A and B insurance along with coverage for Prescription drug costs.
Here are some of the Medicare Advantage providers that received the high-performance icon in 2022:
While this list is an excellent start to finding top-notch Medicare Advantage plans, you should always check your individual plan’s Medicare Star Rating before signing up.
This is because a Medicare provider’s rating is calculated on all of its plans, which means that some plans will be rated higher than others.
You can do this by visiting the Medicare.gov website and typing in your ZIP code. Or, if you’d like to speak to a licensed insurance agent about high-performance plans in your area, reach out to PolicyScout by calling 1-888-912-2132, or by emailing Help@PolicyScout.com.
Look at your plan’s costs: Does your plan have high premiums, deductibles, or coinsurance amounts? Compare these to other plans in your county or area and see if you are paying competitive rates.
Deductibles: These are amounts that you will have to cover before your health insurance begins to pay for medical expenses.
Monthly Premiums: These are the fees people have to pay to be members of a health insurance plan.
Coinsurance: These are the portion of medical costs that members have to pay for medical tests, services, and items. The amount you have to pay will depend on the type of expense.
Copayments: A fixed amount that Medicare plan members pay for services, tests, and items. For example, your MA-PD might charge a rate of $10 for you to see a doctor and a rate of $20 to get blood tests done.
Out-of-pocket costs: These are all costs that your plan will not pay for and which you will have to cover.
2. Look at your plan’s services and benefits: Are you satisfied with the coverage and benefits it offers, and are you using all of your benefits?
3. Check the Medicare Star Rating of your plan and provider: Go to the Medicare.gov website and look up your plan. Alternatively, you can speak with a Medicare consultant to find out how your plan is performing this year.
5. Ask friends and family: See if anyone has had good or bad experiences with a particular company or a specific plan. Ask them what they think about their plan’s customer service, benefits, and coverage.
6. Speak with a licensed insurance agent: Get professional assistance with your questions and concerns. A licensed Medicare expert can provide insights, advice, and years of experience.
If you’re considering switching to a Five-Star Medicare Advantage plan, you’ll be able to change plans using the Five-Star Enrollment Period.
The Five-Star Enrollment Period is from December 8th to November 30th. However, keep in mind that you can only do this once each year, and the plan must be available in your area.
Remember to check that the five-star plan you want to join has the same coverage as your current policy.
Some MA-only policies (without prescription drug coverage) are rated as five-star plans. You might lose your prescription drug coverage if you move from an MA-PD plan to an MA-only plan.
You will have to wait until the Fall Open Enrollment Period to get coverage again.
There are three other periods or opportunities to join a Medicare Advantage plan or change to another provider each year.
Open Enrollment Period: Sometimes called the Fall Open Enrollment, this period runs from October to December each year. During your Open Enrollment, you can:
Enroll in Medicare Advantage (if you have Original Medicare).
Sign up for a Prescription Drug Plan.
Change Medicare Advantage plans.
Cancel your Medicare Advantage coverage.
Medicare Advantage Open Enrollment Period: This period runs from January 1st to March 31st. During the MA Open Enrollment, you can:
Switch Medicare Advantage plans.
It’s important to note that you cannot join Medicare Advantage if you have Original Medicare.
Special Enrollment Periods: These exceptional cases allow people to sign up for Medicare, Medicare Advantage, and Prescription Drug Plans outside of the regular enrollment periods.
Here are some circumstances that qualify you for a Special Enrollment Period:
Moving to a new state, ZIP code, or county.
Losing qualifying health coverage.
If you gain a dependent or get married.
Your eligibility for other health care plans changes.
There was an error with your enrollment or plan.
As you can see, there are multiple opportunities to join or change to a five-star Medicare Advantage or a Prescription Drug Plan.
If you need assistance finding out about Medicare plans in your area, reach out to PolicyScout’s licensed Medicare agents on 1-888-912-2132 to get one-on-one advice and guidance.
If you’re interested in learning more about the federal Medicare program, Medicare plans, Medicare terminology, and coverage options, check out the PolicyScout MedicareHub.
If you have specific questions about Medicare five-star plans, reach out to one of our Medicare consultants to get answers and advice.