Medicare Star Ratings: What They Mean (2026)

Every fall, Medicare grades the quality of every Medicare Advantage and Part D drug plan on a 1-to-5 scale. These Medicare Star Ratings are one of the few plain signals a family has for judging a plan before enrolling, and they measure preventive care, chronic-condition management, member experience, and drug safety. This guide explains what each rating category measures, how to pull ratings from Medicare Plan Finder, what the quality bonus means for your benefits, and how the 5-Star Special Enrollment Period lets you switch to a top-rated plan outside the usual fall window.

What do Medicare Star Ratings measure?

CMS calculates Star Ratings from dozens of performance measures grouped into two categories: Health Plan quality (for Medicare Advantage) and Drug Plan quality (for Part D). It scores each contract against thresholds called "cut points" and rolls the measures up into an overall rating. Within those categories, the measures fall into three broad dimensions.1

Health plan measures cover how well a plan keeps members healthy and manages ongoing conditions. Specific measures include breast cancer screening rates, colorectal cancer screening, flu vaccine uptake, controlling blood pressure in members with hypertension, managing blood sugar in members with diabetes, and statin use in people with cardiovascular conditions. Plans that score well on these measures get credit for delivering care that actually reduces hospitalizations and complications, not just for processing claims.

Member experience measures capture what enrollees report about their plan. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey asks members whether it was easy to get needed care, how quickly they got appointments, how well doctors communicated, and how they rate the plan overall. These survey scores make up a meaningful slice of the total rating, because a plan can hit clinical benchmarks on paper while still leaving members unable to get timely appointments.

Drug plan measures (for Part D, whether standalone or built into a Medicare Advantage prescription drug (MA-PD) plan) track medication safety and adherence. Measures include medication adherence for diabetes, hypertension, and cholesterol medications; safe prescribing practices; completion of medication reviews; and screening for high-risk drugs. A plan that scores well here is actively working to keep members on their medications and flag dangerous drug combinations, not just dispensing at a cost.

CMS weights some measures more heavily than others, and a plan must meet a minimum enrollment threshold before a reliable rating can be calculated. A new or low-enrollment plan may carry a "plan too new to be rated" designation and show no star rating on Plan Finder. That is not a zero-star verdict; it simply means CMS does not yet have enough data. At the other end, CMS flags a consistently weak plan with a "low performer" icon on Plan Finder when it has scored fewer than 3 stars for three years in a row.1

How do Star Ratings affect your benefits and costs?

Plans rated 4 stars or higher receive quality bonus payments from CMS. Under the Affordable Care Act, these plans get a percentage increase applied to their base payment rate. The additional revenue allows 4-and-5-star plans to offer lower premiums, reduced cost-sharing, or extra supplemental benefits (including dental, vision, hearing, and fitness programs) that plans without the bonus cannot afford at the same price point.1

For 2026, the Centers for Medicare & Medicaid Services estimates the average Medicare Advantage monthly plan premium at about $14.00, down from $16.40 in 2025. Higher-rated plans tend to cluster at the lower end of that premium range because the bonus payments reduce the per-member cost. You still owe your Part B premium regardless of your plan's star rating.2

A higher rating is not a guarantee of lower cost, though. Star Ratings measure quality, not price, so treat the star number as a tiebreaker rather than the decision. Confirm first that a plan covers your doctors, your prescriptions, and gives you an out-of-pocket maximum you can live with, then break ties on the rating. A 5-star plan that does not cover your medications is still the wrong plan.

The 5-Star Special Enrollment Period

This is the enrollment right most beneficiaries do not know exists. Under federal rules, if a 5-star Medicare Advantage, Part D, or Medicare Cost plan is available in your area, you can use the 5-Star Special Enrollment Period (SEP) to switch to it from your current plan, outside the fall Annual Election Period (October 15 through December 7) and the Medicare Advantage Open Enrollment Period (January 1 through March 31).1

How the 5-Star SEP works:

• You can use it once between December 8 and November 30 of the following year.
• The 5-star plan must be available and accepting enrollment in your service area.
• Coverage in the new plan starts the first day of the month after the plan receives your enrollment request.
• You can enroll by calling 1-800-MEDICARE or the plan directly. You do not have to do it online.

One trap to avoid: if you switch from a Medicare Advantage plan that includes drug coverage to a 5-star plan that does not, you can be left without Part D. Before you switch, confirm the 5-star plan includes the prescription drug coverage you need, so you are not caught paying out of pocket or waiting for the next enrollment window to add it.

The practical value is real, but the limitation is supply. Not every county has a 5-star plan, and for 2026 only 18 contracts nationally reached that threshold. If a 5-star plan enters your area mid-year, or you become dissatisfied with your current plan between enrollment periods, the 5-Star SEP gives you an exit the standard calendar does not.1

One clarification: the 5-Star SEP applies to the plan's rating for the plan year you are switching into, not the prior year's rating. A plan can gain or lose 5-star status from one year to the next, so verify the current rating on Plan Finder before submitting an enrollment request.

How to use Medicare Plan Finder to compare Star Ratings

Medicare Plan Finder at medicare.gov/plan-compare is where CMS publishes plan ratings alongside premium, cost-sharing, and formulary data.1

The category-level breakdown matters. A plan might score 4.5 stars overall but only 3 stars on member experience, which can signal difficulty reaching customer service or getting specialist referrals. If access and responsiveness are priorities for you, the category breakdown tells you more than the summary number. Plan Finder also shows the prior year's rating for context, so you can see whether a plan's quality is trending up or down.

Which enrollment window lets you switch plans?

Star Ratings intersect with three enrollment windows. Knowing which one applies keeps you from missing a switch opportunity.3

Annual Election Period (October 15 through December 7). This is when most people review and change their Medicare coverage for the coming year. Any Medicare beneficiary can switch plans during this window, and changes take effect January 1. Plan Finder publishes updated Star Ratings for the upcoming plan year before October 15, so you can compare current ratings before you commit.

Medicare Advantage Open Enrollment Period (January 1 through March 31). People already enrolled in a Medicare Advantage plan may make one change: switch to a different MA plan, or return to Original Medicare and add a Part D plan. Coverage changes take effect the first day of the month after enrollment.

5-Star Special Enrollment Period (once between December 8 and November 30). Described above. This is the only window that lets you switch based on quality, outside the standard calendar, as long as a 5-star plan is available in your area.

For more detail on the enrollment calendar, see the Medicare enrollment periods guide.

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