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What are Medicare Stars and What Do They Mean to Me?

We’re all familiar with the role of a Michelin star in the restaurant world: three stars mean “exceptional cuisine,” while one star means “a very good restaurant.”

When it comes to Medicare Advantage and Part D health insurance plans, star ratings play a similarly important role.

The Star Rating System is used by Medicare to measure and show how well Medicare Advantage and Medicare Part D plans perform in providing high quality of care and positive experience to its members. One star is the lowest, while five stars are the highest.

Medicare Advantage plans are run by private health insurance companies and cover everything that Original Medicare (Medicare Part A – hospital and Part B – medical) covers, as well as additional benefits that typically include prescription drugs, dental care, routine vision and hearing visits. They are evaluated based on how well the plans perform in these categories:

  • Staying healthy: Access to screenings, tests and vaccines
  • Managing chronic conditions
  • Timely and accurate responsiveness
  • Handling member complaints
  • Customer service
  • Member experience

Part D plans are standalone plans that only cover prescription drugs. They can be paired with Original Medicare, Medicare Supplement or any Medicare plan that doesn’t include prescription drug coverage. They are evaluated based on how well the plans perform in these categories:

  • Drug pricing accuracy and medication safety
  • Handling member complaints
  • Customer service
  • Member experience

Members can use the Medicare Star Rating System to compare plans as they make their elections. Plans receive ratings from the Centers for Medicare & Medicaid Services on individual categories and are given an overall rating. The ratings are updated each October in time for the annual election period, which runs from Oct. 15 to Dec. 7. Star ratings are available online or by calling 1-800-Medicare.

If a plan receives a rating of less than three stars for three years in a row, Medicare will flag it as low performing. This is an indication that you may want to check to see if the plan is still a good fit for you.

For the very few Medicare plans that receive the elite five-star rating, there is a special enrollment period from Dec. 8, 2021 to Nov. 30, 2022 that allows members to switch from other Medicare plans to a five-star Medicare Advantage or Part D plan. Members can only use this special enrollment period once during that time.

For more information about Medicare and Medicare Advantage plans offered by Blue Cross, visit goconfidently.com and bcbsm.com.

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