How do Medicare Advantage star ratings affect the quality of care I can expect?

Question

Leslie Helene Sussman · Accepted Answer

Generally, yes star ratings are an important factor when choosing a plan.

Medicare rates plans based on their health and drug services from poor to excellent. (1 to 5 stars)

5 star rating is the highest/Excellent.

Star ratings are based on factors that include:

1. Feedback from members about the plan's service and care
2. The number of members who left or stayed with the plan
3. The number of complaints Medicare got about the plan
4. Data from doctors and hospitals that work with the plan

Marsha Reiniers · Answer

Each year, in an effort to assist you in making a decision about a particular Medicare Advantage or RX plan, CMS, The Center for Medicare Services, rates each plan from one to a five-star rating as a way to measure how those plans perform.  These star ratings are based on at last 50 different parameters.  The higher the star rating, would indicate that the plan has met those different parameters of measurement better than another plan.   Each carrier strives to improve their star ratings as can result in extra money for extra benefits for its members. 
To answer this question, the quality of care you may receive from a provider is going to be dependent on that particular provider in the clinical situation.

Gregg Matheny · Answer

Medicare advantage ratings are a great way to rate the effectiveness of a plan. If you just go off of a plans benefit amounts, you may be turning a blind eye to poor service or low network quality. The star ratings really do give an accurate description of how well or poor a plan performs..

Answered by Gregg Matheny on March 25, 2025

Agent Licensed in AZ & UT

Answered by Gregg Matheny Medicare Insurance Agent

Steve Brauer · Answer

Medicare Advantage Plans are incentivized to not only give good service to their enrollees but also to proactively strategize people's healthcare. When one of their enrollees ends up in the hospital or has a chronic illness that is not treated properly, the Advantage plan is penalized, meaning it affects their star rating on that plan. The better the star ratings for a plan are, the more money they get from the federal government.

Answered by Steve Brauer on April 8, 2025

Broker Licensed in AZ & CA

Answered by Steve Brauer Medicare Insurance Agent

Fred Manas · Answer

Medicare Advantage star ratings provide a general indicator of a plan's quality and can influence the level of care you can expect. A higher star rating (5-star being the highest) generally suggests a better overall experience and higher quality of care, while a lower rating may indicate areas where the plan needs improvement.

Answered by Fred Manas on April 24, 2025

Agent Licensed in NY, CT, DC & 7 other states

Answered by Fred Manas Medicare Insurance Agent

Tony Hardwick · Answer

Plans with a star rating of 4 and above receive bonus payments and may offer enhanced benefits, while lower ranked plans may face payment penalties or decreased enrollment.

Chuck Winslow · Answer

Medicare Advantage star ratings measure a plan’s quality based on things like member satisfaction, customer service, and healthcare outcomes. Generally, higher-rated plans (4 or 5 stars) are a good sign that you can expect better customer service, more reliable access to care, and higher overall satisfaction compared to lower-rated plans.

Answered by Chuck Winslow on April 28, 2025

Agent Licensed in IN

Answered by Chuck Winslow Medicare Insurance Agent

Jami Mead · Answer

A high star rating (4 or 5 stars) is given to doctors or facilities who are more likely to prioritize and improve customer service, care, and member experience, leading to better health outcomes. Focus on the patient is their priority.

Answered by Jami Mead on April 21, 2025

Broker Licensed in OH, FL, GA & 11 other states

Answered by Jami Mead Medicare Insurance Agent

How do Medicare Advantage star ratings affect the quality of care I can expect?

Agents: Share Your Expertise

Seniors: Ask a Question of Your Own

Related Questions

Agent Locator

Medicare Agents Hub
A non-government resource website

How do Medicare Advantage star ratings affect the quality of care I can expect?

Agents: Share Your Expertise

Seniors: Ask a Question of Your Own

Related Questions

Agent Locator

Medicare Agents HubA non-government resource website

Medicare Agents Hub
A non-government resource website