The Centers for Medicare & Medicaid Services (CMS) rates all Medicare Advantage and Medicare Prescription Drug Plans each year. The range for the rating is between 1 and 5, and is designated by stars with 1 star being the lowest rating and 5 stars being the highest or best rating. The purpose of the rating is to measure the quality of health care and drug services received by beneficiaries enrolled in Medicare Advantage (MA) and Medicare Prescription Drug Plans (MAPD or stand-alone PDP).
Over forty quality and performance measures are used in the evaluation of plans. Assessment of the data, along with clinical recommendations and feedback from Medicare beneficiaries using the plans are used to determine the ratings.
The ratings are released each year in the fall, and the plans must include their star rating from Medicare in their member materials. Star ratings can help members evaluate plans. They are also used to determine if a Medicare plan qualifies for the 5-Star Special Enrollment Period or if the Medicare Plan falls into the consistently low performing Special Enrollment Period.