Heeee’s back… In just a few short weeks, you might start seeing Joe Namath on TV again, promising the “best benefits from every Medicare plan in the United States” packaged into one perfect plan that no one can buy — and warning, “You may be missing out!”
If you’re 65 or older, your mailbox will also be full of glossy flyers from nearly every company with a Medicare plan. It can feel overwhelming.
That’s why, over the next several weeks, I’ll be publishing a series of blogs that answer the most common Medicare questions we hear from clients.
This week’s topic: What Are Medicare Star Ratings?
Why Do Star Ratings Matter?
When you’re comparing Medicare Advantage or Prescription Drug Plans, one helpful tool is the Medicare Star Rating system. Each plan is scored from 1 to 5 stars based on quality, service, and outcomes. Medicare updates these ratings every October.
- Plans with 4 or more stars are considered “above average.”
- 5-star plans can be joined once per year outside of regular enrollment.
- Higher-rated plans may also receive bonus funding, which companies sometimes use to add richer benefits.
FAQ: What is a good star rating for a Medicare plan?
- Generally, 4 or more stars is a strong indicator of quality.
How Are Medicare Advantage Plans (MAPDs) Rated? Medicare Advantage plans — with or without drug coverage — are rated on both healthcare quality and member experience.
Key measures include:
- Staying Healthy: preventive screenings and checkups.
- Managing Chronic Conditions: diabetes, blood pressure, cholesterol.
- Member Experience: satisfaction surveys and communication.
- Complaints & Plan Performance.
- Customer Service.
- Drug Safety & Pricing (if drug coverage is included).
Some of these measures are outside the company’s direct control. For example, whether members actually get their annual checkups or manage chronic conditions is up to the individual. That’s why insurers may call to schedule a home visit or even offer gift cards for completing preventive exams — it helps boost these scores.
Other measures can feel unfair. A complaint against the broker because a doctor turned out to out-of-network or a drug not being covered counts against the insurance company — even though your broker likely compared multiple carriers, and the same doctor may appear in several networks. Similarly, complaints about a doctor’s office can hurt a plan’s rating, even if that provider works with many insurers.
FAQ: Do higher star ratings mean better benefits?
- Sometimes. Higher funding can allow for extra benefits, but network and coverage details still matter more.
How Are Prescription Drug Plans (PDPs) Rated?
Stand-alone drug plans (PDPs) don’t cover medical care, so their ratings focus only on prescription-related quality.
Key measures include:
- Member Experience with the drug plan.
- Drug Safety & Accuracy of Pricing.
- Complaints & Plan Performance.
- Customer Service.
As with Medicare Advantage, not all measures are fully under the company’s control. For example, Drug Safety & Pricing works like this:
- Safety: Plans are scored on whether members are prescribed safer alternatives and whether treatments follow guidelines. Because doctors write prescriptions and pharmacies fill them, the insurance company often needs to follows after the fact — contacting prescribers or pharmacies when they feel a safer option is available.
- Pricing: Medicare checks if the drug prices listed on its Plan Finder tool match what members actually pay at the pharmacy. Errors can come from the pharmacy, the plan, or even Medicare’s own system.
In short: this measure ensures plans are helping members stay safe with prescriptions and keeping drug costs transparent.
FAQ: What does “drug safety” mean in star ratings?
- It refers to avoiding high-risk medications, promoting safer alternatives, and supporting members in taking prescriptions as directed.
MAPD vs. PDP: Key Differences
- MAPD ratings: include both medical care + drug coverage.
- PDP ratings: focus only on drug coverage.
FAQ: What’s the difference between MAPD and PDP star ratings?
o MAPD looks at healthcare + drug coverage, while PDP looks only at prescriptions.
Should You Choose a Plan Based on Star Ratings?
Star ratings are a useful guide, but they aren’t everything. Before choosing a plan, make sure to check:
- Are your doctors and hospitals in-network?
- Are your prescriptions covered affordably?
- What are the total costs (premiums, copays, deductibles)?
A 5-star plan might score highest overall but still leave out your doctor, exclude your medications, or lack benefits like dental or hearing. In those cases, a 3- or 4-star plan could be a better fit.
FAQ: Are 5-star plans always the best?
- They rate highest on quality, but the “best” plan is the one that fits your needs and budget.
In Closing
Choosing the right Medicare plan isn’t just about cost — it’s about balancing quality, coverage, and personal fit. Star ratings are helpful, but they should be your final tiebreaker, not your first step. If two plans meet your needs and budget, then the star rating can help you decide.
Next Week:
Original Medicare with a supplement, or Medicare Advantage? It’s one of the toughest choices retirees face — and next week, I’ll help make it clearer.