What Are Medicare 5-Star Plans And Why Are They Important?

Medicare 5-Star Plans From CMS for 2021

CMS uses a 5-Star rating system to measure how well Medicare Advantage (MA) and Part D plans perform. They use information from member satisfaction surveys, plans, and health care providers to give an overall performance star rating to plans, according to medicare.gov. Ratings range from one to five stars, with five being the highest and one being the lowest. These ratings help beneficiaries compare plans based on quality and performance.

Medicare updates these ratings each fall for the following year. This year, there are 28 contracts earning a 5-star rating from CMS. 21 are MA-PD contracts, two are Medicare Cost contracts, and five are PDPs. Carriers include KelseyCare Advantage, Kaiser Foundation, UnitedHealthcare, CarePlus by Humana, Tufts Health Plan, Health Partners, Capital District Physicians’ Health Plan, Quartz Medicare Advantage of Wisconsin, Cigna, Health Sun – Anthem, BCBS – Health Now New York, Martins Point, and more. See the full list here.

2021 Star rating map by CMS.gov

Five-Star MA Plans

How are Medicare Advantage plans rated?

Medicare Advantage Plans, also known as Part C, are rated on how well they perform in five different categories. CMS then assigns the plan one overall star rating to summarize the plan’s performance as a whole.

  • Staying healthy: screenings, tests, and vaccines
  • Managing chronic (long-term) conditions
  • Plan responsiveness and care
  • Member complaints, problems getting services, and choosing to leave the plan
  • Health plan customer service

How are Part D plans rated?

Part D plans, or PDPs, are rated on how well they perform in four different categories:

  • Drug plan customer service
  • Member complaints, problems getting services, and choosing to leave the plan
  • Member experience with the drug plan
  • Drug pricing and patient safety


Why Are Medicare 5-Star Plans Important?

5-star plans are important because CMS allows these plans an extended enrollment period. Medicare beneficiaries have a one-time opportunity to switch to a 5-star Medicare Advantage Plan, Medicare Cost Plan, or Medicare Prescription Drug Plan between December 8 and November 30.

If beneficiaries move from a MA Plan that includes prescription drug coverage to a stand-alone PDF, they will be disenrolled from the MA Plan, including the health benefit. Beneficiaries will be returned to Original Medicare health coverage. You can only switch to a 5-star Medicare Prescription Drug Plan if one is available in your area.

If beneficiaries move from a MA Plan that has drug coverage to a 5‑star MA Plan that does not, they may lose prescription drug coverage. You will have to wait until the next enrollment opportunity to get drug coverage and may have to pay a Part D late enrollment penalty.

Visit https://www.medicare.gov/plan-compare/ to find and compare health and drug plans.

Got Medicare Questions?

We hope this information on Medicare 5-star plans is helpful to you. If you have questions about Medicare Advantage insurance and if it is right for you, call Empower today. 1-888-446-9157

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