What is medicare star rating and why should every Medicare beneficiary pay attention to it? The Centers for Medicare & Medicaid Services (CMS) assigns a quality score of 1 to 5 stars to every Medicare Advantage and Part D prescription drug plan in the country. These ratings measure real performance across dozens of categories. They include clinical outcomes, customer service, drug safety, and member satisfaction. CMS updates the scores every October, just before the Annual Enrollment Period begins. For 2026, the average Medicare Advantage plan score dropped to 3.
65 stars — down from 3.92 in 2025. That decline makes checking ratings more important than ever. Plans with higher stars typically offer lower premiums and better extra benefits. Plans with low ratings may face CMS sanctions or even lose their contracts. Understanding what is medicare star rating can help you avoid a plan that looks affordable but delivers poor care.
How CMS Calculates Medicare Star Ratings
CMS evaluates Medicare Advantage plans on up to 45 quality measures for 2026. These measures pull data from clinical records, pharmacy claims, member surveys, and complaint tracking systems. Each measure receives a weight based on its importance to patient health. Medication adherence measures carry the heaviest weight — triple the standard. For example, whether members consistently take their diabetes, blood pressure, and cholesterol medications counts significantly toward a plan’s overall score.
The five rating categories cover outcomes, clinical processes, patient experience, access to care, and drug safety. CMS uses HEDIS clinical data, CAHPS member surveys, and its own administrative records to score each one. In a notable change for 2026, CMS cut the weight of patient experience measures in half — from 4x to 2x. As a result, many plans that previously scored well on member satisfaction saw their overall ratings decline. Only 207 out of 769 evaluated plans earned 4 or more stars for 2026. That is roughly 27% of all rated plans.
What Is Medicare Star Rating and What Each Level Means for You
Star ratings directly affect what you pay and what benefits you receive. Plans earning 4 or more stars qualify for Quality Bonus Payments from CMS — an extra 5% added to their benchmark funding. In 2025, these bonuses totaled at least $12.7 billion across the Medicare Advantage program. Plans typically pass that money back to members through reduced premiums, lower copays, or added benefits like dental, vision, and fitness programs.
| Star Rating | Quality Level | What It Means for Members |
|---|---|---|
| 5 Stars | Excellent | Qualifies for special enrollment period year-round |
| 4–4.5 Stars | Above Average | Plan receives quality bonus payments; better benefits likely |
| 3–3.5 Stars | Average | No bonus; may still be competitive on cost |
| 2–2.5 Stars | Below Average | CMS flags for improvement; fewer extra benefits |
| 1–1.5 Stars | Poor | Risk of CMS sanctions or contract non-renewal |
Five-star plans unlock a unique advantage. Beneficiaries can switch into a 5-star rated plan at any time during the year through a Special Enrollment Period. For 2026, that window runs from December 8, 2025 through November 30, 2026. However, only 18 contracts nationwide earned 5 stars — so availability depends on your location. Knowing what is medicare star rating at each level helps you weigh whether a plan’s extras justify its network restrictions.
How to Check Star Ratings and Compare Plans
The most reliable place to check ratings is the Medicare Plan Finder at Medicare.gov. Enter your ZIP code, and the tool displays every available plan alongside its star rating, estimated costs, drug coverage, and provider network. You can compare plans side by side. CMS also publishes detailed performance data files on CMS.gov for those who want measure-level breakdowns.
When comparing plans, do not rely on star ratings alone. A 4-star plan with a narrow network may not include your doctors. In contrast, a 3.5-star plan might cover all your providers and medications at a lower cost. Use ratings as one factor alongside premiums, out-of-pocket maximums, drug formularies, and provider directories. Your local SHIP counseling program offers free, unbiased help comparing Medicare options. Typically, SHIP counselors can walk you through what is medicare star rating for each plan in your area and explain the tradeoffs.
Major insurers vary widely in performance. For 2026, approximately 78% of UnitedHealthcare Medicare Advantage members are in plans rated 4 stars or higher. Aetna maintains strong ratings with over 81% of members in 4-star-plus plans, though that dropped from 88% the prior year. Humana experienced the steepest decline, with only about 20% of members in 4-star-or-above plans. Blue Cross Blue Shield PPO options average 4.5 stars nationally. These differences matter because what is medicare star rating for your specific plan — not the insurer’s overall reputation — determines your benefits.
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Frequently Asked Questions
How often do Medicare star ratings change?
CMS releases updated star ratings every October, ahead of the Annual Enrollment Period that runs October 15 through December 7. Ratings reflect performance data from the prior measurement year. As a result, a plan’s rating can shift up or down each year based on its most recent quality scores.
Can I switch plans based on star ratings outside of open enrollment?
Yes, but only into a 5-star rated plan. Medicare offers a Special Enrollment Period specifically for 5-star plans. For 2026, this window runs December 8, 2025 through November 30, 2026. You can use it once per year if a 5-star plan is available in your area.
Do star ratings apply to Original Medicare or Medigap plans?
No. Medicare star ratings only apply to Medicare Advantage (Part C) and Part D prescription drug plans. Original Medicare and Medigap supplemental policies are not rated under this system. In most cases, beneficiaries considering what is medicare star rating are evaluating Medicare Advantage or standalone drug plans during enrollment.
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Official Sources & Resources
For verified information on Medicare regulations and consumer protection:
- Medicare.gov (Official Site): medicare.gov
- CMS (Centers for Medicare & Medicaid Services): cms.gov
- NAIC (National Association of Insurance Commissioners): naic.org
- KFF Medicare Research: kff.org/medicare
- Social Security Administration: ssa.gov
Content last reviewed June 2026. If you notice any outdated information, please contact us.