Plain-English answers to the Medicare questions people actually ask.
A star rating is a single number from 1 to 5 that the Centers for Medicare & Medicaid Services hands every Medicare Advantage plan and every standalone Part D plan once a year. It’s built from things like how many members complained, how quickly customer service answered the phone, how well the plan managed chronic conditions across its whole population, and whether its pricing and claims processing were accurate. What it does not measure is you — not your specific medications, not your specific doctor, not what you’ll actually pay this year.
That’s the gap that trips people up. Someone hears “5 stars” and assumes it means “best plan for me.” It doesn’t. A 5-star plan can still be the wrong fit if it doesn’t cover your prescriptions the way you need, or if the pharmacy you use isn’t in its network at the tier you expect. A 3.5-star plan can be exactly right. The rating tells you something true about how a plan runs day to day — it just isn’t the thing most people assume it is when they see the number on a brochure.
It also isn’t permanent. CMS recalculates every plan’s rating each year using the most recent data available, so the number attached to a plan this year isn’t guaranteed to be the number next year. That matters more than most people expect, and I’ll get into why further down.
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Why This Number Shows Up in Almost Every Plan Conversation
I put the star rating on the table whenever I walk someone through a specific plan, because it’s printed right on the page and I’m not going to hide it or dress it up. The moment it’s visible, people want to know what it means — is it like a restaurant review, is it about the doctors, does a low number mean the plan is bad? Those are fair questions, and the honest answer is that the rating is closer to a report card on the insurance company’s operations than a review of your medical care.
It tends to come up hardest when someone is already juggling more Medicare vocabulary than they wanted to. One person put it to me plainly:
“I guess the part that was confusing to me is that you say part A and then part D and then you start talking about Medicare Advantage and Medicare supplements.”
Star ratings land in the middle of that pile as one more number to sort out. Part of why the number gets outsized attention is marketing. You’ll sometimes see a push around 5-star plans specifically, because there’s a special enrollment window tied to a 5-star rating that lets someone switch outside the usual enrollment period — though availability depends on what’s actually offered where you live. That window is real, but it doesn’t change what the rating is measuring. People also sometimes assume a higher rating means a plan is better at handling their specific chronic condition. It’s closer to the opposite: the chronic-condition measures inside the rating are averaged across everyone the plan covers with that condition, not calculated around your particular case.
So before I ever explain what a rating means, I try to get the bigger picture settled first — which type of plan we’re even discussing — because the rating means something different depending on whether it’s attached to a bundled Medicare Advantage plan or a standalone drug plan.
Related: Read the plain-English guide to Prescription Drug Plans Part D.
What I Ask Before the Star Rating Even Comes Up
The rating is close to useless without context, so before I’ll tell someone whether a specific number should matter to them, I want answers to a handful of questions:
- What medications are you taking right now, including anything new or high-cost? A plan’s drug list changes every year regardless of its rating, and a specialty medication landing on a different tier can swing your cost more than a full star ever will.
- Do you have a pharmacy you’re loyal to, or are you flexible? Preferred-pharmacy pricing inside a plan’s network often matters more to your actual bill than the rating does.
- Have you run into a plan being slow to approve a medication before? That kind of friction is exactly the sort of thing the rating is trying to capture — it’s a real, useful signal when it lines up with someone’s history.
- Are we comparing a standalone Part D plan, or drug coverage bundled inside a Medicare Advantage plan? The two are rated on different scales with different criteria, so the number means something different depending on which one you’re holding.
- Is your decision mostly about the monthly premium, or the total cost across a full year? A high rating on a plan with a mismatched drug list can still leave you paying more over twelve months than a lower-rated plan built around your actual list.
- Do you split time between states or travel for long stretches? Pharmacy access away from home is a real cost driver the star number doesn’t touch.
- 1Your current medicationsDrug list changes yearly, regardless of the plan’s rating
- 2Your pharmacyPreferred-pharmacy pricing often matters more than the rating
- 3Past authorization delaysSignals whether the rating’s service measures apply to you
- 4Standalone Part D vs. bundledEach is rated on a different scale and different criteria
- 5Premium vs. full-year costA high rating with a mismatched drug list can cost more
- 6Travel or multi-state livingPharmacy access away from home isn’t part of the rating
Where It Actually Applies — By Type of Plan
Star ratings don’t apply evenly across Medicare. Where the rating shows up, and what it’s measuring, depends on which kind of coverage you’re comparing:
A Medicare Advantage plan with built-in drug coverage gets one blended rating that covers both the medical side and the drug side together. The trade: it’s convenient to compare at a glance, but a strong overall score can mask a weak drug list, because the medical-side measures can carry more weight in the blend than the piece you actually care about.
A standalone Part D plan, paired with Original Medicare or a Supplement, gets its own separate rating built purely from drug-plan measures — customer service, complaints, and pricing accuracy on the drug side specifically. The trade: you’re managing two products and two enrollment decisions instead of one, but the rating you’re looking at is a cleaner read on the thing it’s actually rating.
A Supplement isn’t rated at all. It’s a standardized product regulated at the state level, not a managed plan CMS grades on performance, so there’s no star number attached to it in the first place. If you’re comparing a Supplement-plus-drug-plan approach against a Medicare Advantage plan, only half of that comparison carries a rating.
This is why the same question — what does the star rating mean — gets a different answer depending on which comparison is actually on the table. If you’re weighing two Medicare Advantage plans against each other, the rating is doing real comparative work. If you’re weighing a Medicare Advantage plan against a Supplement-plus-drug-plan combination, the rating only exists on one side of that comparison, and leaning on it too hard tilts the decision toward the option that happens to have a visible number.
See where you land. If you would rather just talk it through with someone who does this every day, Most people can sort the direction quickly once the doctors, drugs, budget, and timing are on the table.
Why I Treat the Rating as a Tiebreaker, Not a Filter
If someone is down to two plans that both cover their medications well, both include their pharmacy at a good tier, and both land in a similar place on cost, I’ll use the star rating to help settle it. At that point it’s a legitimate, data-backed signal about how the company behind the plan actually runs its operations — and operations are exactly what you deal with all year: the phone line, the appeals process, how cleanly claims get paid.
What I won’t do is let the rating override a drug-list and network check. The cost of getting that order backwards is real: you can end up locked into a plan that scores well on paper but doesn’t cover the one medication that matters to you, and you’re stuck with that mismatch until the next enrollment window opens. A number on a brochure doesn’t fill a prescription. Your actual drug list does.
When I’d Tell You the Rating Matters More Than I’m Giving It Credit For
I don’t want to undersell the number, because there are real situations where it should carry more weight than a tiebreaker.
When a plan has scored low for several years running, not just once. A single off year can be noise — a slow season for a call center, a rough patch in claims processing. A pattern across multiple years is different. That’s usually a real, structural problem with how the plan is run, and it’s worth taking seriously even if the drug list looks fine on paper.
When you know you’ll be on the phone with the plan often. If you’re someone who calls customer service regularly — sorting out a claim, checking on an authorization, asking questions — the service measures baked into the rating are describing an experience you’re actually going to have. For someone who rarely calls, that same measure matters much less.
When you’re managing an ongoing condition and the plan’s measures reflect it directly. Some of what feeds the rating is how well a plan manages chronic conditions across its population — follow-up care, medication adherence tracking, that kind of thing. If you have a condition that needs consistent management, that piece of the rating is closer to relevant for you than it is for someone who rarely sees a doctor.
When two plans are genuinely close on everything else. This is the tiebreaker case from the section above, and it’s worth restating here: once the drug list and pharmacy access are equal, the rating stops being decoration and starts being the most honest data point left on the table.
When you’ve had a bad experience with slow prior authorizations before. If that’s happened to you, the rating’s member-complaint and service measures are picking up on the exact kind of friction you’re trying to avoid a second time. In that case, weight it more, not less.
Which side of that line are you on?
That is exactly the question a short Medicare conversation settles. You get me, not a call center.
What Surprises People About the Rating
The number moves. A plan that carried a strong rating one year can drop the next, and a plan someone dismissed can climb. CMS reassesses every plan annually, so the rating you’re looking at right now is a snapshot, not a permanent grade. I’ve walked people through plans where the number changed enough between one fall and the next that it was worth a second look.
The second surprise is the Supplement gap. People assume every piece of Medicare gets graded the same way, and when they learn a Supplement carries no rating at all, it usually reframes the whole conversation — the question stops being “which number is higher” and becomes “which structure fits how I actually use care.”
The third surprise is how much of the rating is about the company’s operations rather than your health outcomes. It’s measuring things like complaint volume and call-center wait times far more than it’s measuring whether your specific condition gets managed well by your specific doctor.
The fourth surprise is what actually gets measured underneath that. People expect the rating to be entirely about clinical outcomes — did the plan help you get better. Some of it is. But a meaningful share is administrative: whether the plan’s provider directory was accurate, whether appeals got reviewed on time, whether pricing information matched what a member was actually charged. Those things affect your life in real ways, just not the way most people picture when they hear “quality rating.”
Let’s Look at the Actual Number Behind Your Plan
A star rating is one real data point in a decision that has several. If you want to know what a specific plan’s rating actually reflects — and whether your medications and pharmacy would even be covered well under it — that’s a fifteen-minute conversation, not a guessing game with a brochure.
Call me at (270) 721-5069, or book a time that works for you, and I’ll walk through the rating, the drug list, and the network side by side so you’re comparing the whole picture instead of one number on a page.
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Questions people ask me about this
Do Medicare star ratings change every year?
Yes. CMS recalculates every Medicare Advantage and Part D plan’s rating annually using the most recent performance data, so a plan’s number this year isn’t guaranteed to hold next year. It’s worth checking again each fall rather than assuming last year’s rating still applies.
Does a higher star rating mean lower drug costs?
Not necessarily. The rating measures things like customer service, complaints, and pricing accuracy across the whole plan, not what you’ll pay for your specific medications. A lower-rated plan with your drugs on a better tier can cost you less over the year than a higher-rated plan that doesn’t.
Do Medicare Supplements have star ratings?
No. Supplements are standardized products regulated at the state level, not managed plans that CMS grades on performance, so there’s no star number attached to them. If you’re comparing a Supplement-and-drug-plan combination to a Medicare Advantage plan, only the Advantage side and the drug plan carry a rating.
Can I switch to a 5-star plan whenever I want?
There’s a special enrollment window tied specifically to 5-star plans that lets you switch outside the usual enrollment periods, but it depends on whether a 5-star option is actually offered where you live. It’s a real window, though it doesn’t change what the rating itself is measuring.
Does the star rating account for my specific doctors or medications?
No. It’s calculated across everyone enrolled in that plan, not built around your individual situation. Two people on the same plan can have completely different experiences even though they’re looking at the same star number.
Where can I check the current rating for a plan I’m considering?
I can pull it up alongside the plan’s actual drug list and network when we talk, so you’re seeing the rating in context instead of on its own. Call (270) 721-5069 or book a time and I’ll walk through it with you.
Keep reading
Start with the basics
More questions I get asked
- Recovery Care and Home Health Care With Medicare: The Part People Usually Assume Wrong
- Does Medicare Pay for Durable Medical Equipment? Here’s What I Tell People Managing a Chronic Condition
- Getting Medicare Before 65 Through Disability: How It Actually Works
- Medicare Advantage vs. Original Medicare: How I Actually Walk Clients Through It
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Written by Michael Smith, licensed insurance broker and founder of Guardian Health & Wealth in Bowling Green, Kentucky. I help people across the country make sense of Medicare : and I will tell you when the popular answer is not your answer.
Drawn from real conversations over the years. I never share anyone’s personal information : just the thinking, so you can see how a decision like this gets made.