Medicare Star Ratings

Medicare Star Ratings

What are Star Ratings?

  • Star ratings, compiled annually by Medicare, are an unbiased way to compare Medicare Advantage plans based on quality, value and performance.
  • Health and pharmacy services are rated together through information gathered from clinicians, member surveys and other trusted sources.
  • Stars for each plan show how well the plan performs cumulatively on a set of quality measures, designed to help Medicare beneficiaries objectively choose a plan.
  • Ratings are based on a five-star scale, with one star meaning “poor” quality ranging up to five stars for “excellent” quality.

How are Star Ratings measured?

Health Services:

  • Staying healthy: Rates how often members got various screening tests, vaccines and other checkups to help them stay healthy.
  • Managing chronic (long-term) conditions: Rates how often members with different conditions got certain tests and treatments to help them manage their condition.
  • Member experience with the health plan: Rates member satisfaction with the plan based on how easy it is to get needed care, appointments, information and help from the plan (customer service).
  • Member complaints and changes in the health plan’s performance: Measures how many complaints Medicare received about the health plan, the number of members who chose to leave the plan and how the health plan’s quality improved or declined from the previous year.
  • Health plan customer service: Rates the timeliness and fairness of the health plan’s appeals decisions.

Drug Services:

  • Drug plan customer service: Rates how well the drug plan handles calls and makes decisions about member appeals.
  • Member complaints and changes in the drug plan’s performance: Measures how many complaints Medicare received about the drug plan, the number of members who chose to leave the plan and how the drug plan’s quality improved or declined from the previous year.
  • Member experience with drug plan: Rates member satisfaction.
  • Drug safety and accuracy of drug pricing: Rates how well the drug plan prices prescriptions and provides updated information on the Medicare website. Also rates information on how often members with certain medical conditions get prescription drugs that are considered safer and clinically recommended for their condition.

To download a flyer, which includes the above information, that you can hand out to your staff or patients, click here.

For more information about how Star Ratings are measured visit medicare.gov.