What are Medicare star ratings?
The Centers for Medicare and Medicaid Services uses a star rating system to evaluate Medicare Advantage plans and Medicare Part D plans. Plans can receive from one star (poor) to five stars (excellent), and the ratings are based on numerous metrics, including factors such as customer service, how easy it is for enrollees to receive care, how well the plan does at improving or maintaining members’ physical and mental health, and how quickly the plan handles appeals – among many others. (See Tables 7, 8, and 9).
There are up to 40 metrics for Medicare Advantage plans with Part D coverage (MA-PDs), up to 30 metrics for Medicare Advantage plans without Part D coverage, and up to 12 metrics for stand-alone Part D plans (PDPs).
Star ratings are assigned at the contract level, rather than the plan level. Most contracts have numerous plans, but all plans under a given contract receive the same star rating. Some contracts do not receive star ratings, either because sufficient data are not available, or because the contract is too new.
For 2025, the average Medicare Advantage plan with integrated Part D coverage (MA-PD) received 3.92 stars, down from 4.04 in 2024 (the average is weighted by enrollment). And the average stand-alone Part D plan received 3.06 stars (down from 3.11 in 2024). CMS reported that approximately 62% of MA-PD enrollees in 2024 were enrolled in plans that would have at least four stars in 2025, but only about 5% of PDP enrollees in 2024 were in plans that had received four or more stars for 2025.
Overall average star ratings are lower for 2025 than any time in the last few years, and the number of MA-PD contracts with five stars for 2025 — only seven — is significantly lower than it had been in recent years. Part of the reason for the decline in 2024 and 2025 ratings is due to the introduction of a new methodology that removed extreme outliers from the data, mostly on the lower end of the spectrum. This made it more challenging for plans to earn 4 or 5 stars, and will result in lower rating-based bonuses for plans. Some insurers have sued the federal government in 2024 over the star ratings methodology, or appealed the ratings for 2025.
Which Medicare contracts received 5-star ratings for 2025?
For 2025, there are a total of 11 Medicare contracts nationwide that have a 5-star rating (down from 36 in 2024). Two are Medicare cost plans, seven are MA-PDs, and two are stand-alone Part D plans (see Tables A1, A2, and A3 here for details about the plans that received 5-star ratings for 2025).
The following contracts have 5-star ratings for 2025. Some of these plans are EGWPs, which means they’re only available via an employer that offers them, rather than being available for individual Medicare beneficiaries to purchase.
2025 5-Star Medicare Advantage plans with Part D coverage (MA-PDs)
- Highmark Health
- Leon Health
- Network Health
- Alignment Health Plan of North Carolina
- Healthsun Health Plans (Elevance Health)
- MCS Advantage
- Optimum Healthcare (Elevance Health)
All together, those seven MA-PD contracts have fewer than 600,000 enrollees in 2024.
5-Star Medicare cost plans
- Medical Associates Clinic Health Plan
- Dean Health Plan
The two 5-star cost plan contracts have fewer than 17,000 enrollees in 2024.
5-Star Stand-alone Part D plans
- UPMC Health Benefits, Inc.
- Independent Health Benefits Corp.
The two 5-star cost plan contracts have fewer than 9,000 enrollees in 2024.
What is the 5-star special enrollment period?
If there’s a 5-star plan available in a given area, Medicare beneficiaries in that area have an opportunity to switch to that plan throughout most of the year (from December 8 through November 30). But although the majority of Medicare Advantage plans (and quite a few stand-alone Part D plans) receive at least four stars, very few receive five stars. The 5-start special enrollment period (SEP) is only available to you if there’s a 5-star plan in your area (available to you, meaning it’s not available just to employees/retirees of a particular business) and you’re choosing to enroll in it during the SEP.
Footnotes
