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Understanding the Medicare Star Quality Ratings - 2024
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.


Each year, Medicare measures Medicare plans using various measures. An overall star rating is calculated for each plan. A summary rating of prescription drug plan quality and a separate summary rating of health plan quality are calculated where appropriate.

This section explains how the star ratings are calculated and provides examples of plan quality.


For plans covering health services and no prescription drug coverage (MAs), the overall score for quality is the same as the summary rating of health plan quality.

For plans covering only prescription drugs and no health services (PDPs), the overall score for quality is the same as the summary rating of drug plan quality.

For plans covering both health services and prescription drug coverage (MAPds), the overall score for quality calculated from the underlying topics from both the health plan summary and the drug plan summary.




Overall Star Rating

The Overall Star Rating is used to determine if a Medicare plan qualifies for the 5-Star Special Enrollment Period or if the Medicare plan falls into the consistently low performing Special Enrollment Period.

The Overall Star Rating combines scores for the types of services each plan offers: What is being measured?




Summary Rating of Health Plan Quality

What is being measured? For plans covering health services, the overall score for quality of those services covers many different topics that fall into 5 categories:
  • Staying healthy: screenings, tests, and vaccines. Includes whether members got various screening tests, vaccines, and other check-ups that help them stay healthy.
  • Managing chronic (long-term) conditions: Includes how often members with different conditions got certain tests and treatments that help them manage their condition.
  • Member experience with the health plan: Includes ratings of member satisfaction with the plan.
  • Member complaints and changes in the health plan’s performance: Includes how often Medicare found problems with the plan and how often members had problems with the plan. Includes how much the plan’s performance has improved (if at all) over time.
  • Health plan customer service: Includes how well the plan handles member appeals.




Summary Rating of Prescription Drug Plan Quality

This summary rating gives an overall score on the drug plan’s quality and performance in many different topics that fall into 4 categories:
  • Drug plan customer service: Includes how well the plan handles member appeals.
  • Member complaints and changes in the drug plan’s performance: Includes how often Medicare found problems with the plan and how often members had problems with the plan. Includes how much the plan’s performance has improved (if at all) over time.
  • Member experience with plan’s drug services: Includes ratings of member satisfaction with the plan.
  • Drug safety and accuracy of drug pricing: Includes how accurate the plan’s pricing information is and how often members with certain medical conditions are prescribed drugs in a way that is safer and clinically recommended for their condition.
This information is gathered from several different sources. In some cases it is based on member surveys. In other cases, it is based on reviews of billing and other information that plans submit to Medicare results from Medicare’s regular monitoring activities.




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  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.
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