Medicare Advantage plans and Prescription Drug plans can earn a star rating from one to five stars. A 2-star rating means below average performance and a 5-star rating is considered excellent.  Currently, no Medicare plans have a star rating of less than a 2-stars.  Medicare uses information from member satisfaction surveys, plans, and health care providers to give overall performance star ratings to Medicare plans. These ratings are an incentive for Medicare plans to improve plan quality by making it easier for beneficiaries to compare and choose plans based on quality and performance.

For plans covering health services, the overall score for quality of those services covers 36 different topics in five categories. For plans covering prescription drug services, the overall score for quality of those services covers 17 different topics in four categories. For plans covering both health and prescription drug services, the overall quality score quality for those services covers all 53 topics in nine categories.

An overall plan rating is then calculated and gives the beneficiary a single summary score that makes it easier to compare plans based on quality and performance. The overall CMS plan rating is included in the optional plan features on our PDP-Finder and MA-Finder tools.  Example: California Medicare Prescription Drug Plans. Example: Broward County, Florida Medicare Advantage Plans.

A review of historical data for 2012 and 2013 shows a surprising drop in Medicare plan quality ratings rather than the expected increase.


2012 Medicare Plans:
The 2012 Medicare plans, shown in the chart below carried an average star rating of 2.94 for stand-alone Prescription Drug plans (PDPs) and an average star rating of 3.25 for Medicare Advantage plans.

*Medicare uses the term plan(s) to mean the contract identifier associated with the plan.  In the chart above the total plans is the total number of unique contract id (ex: H1234 or S1234).
**Medicare Advantage plans include all types (Cost, PFFS, HMO, PPO, regional and local). If the same contract was offered with and without prescription drug coverage, it was only counted once.


2013 Medicare Plans:
In comparison, the 2013 Medicare plans, shown in the chart below carried an average star rating of 3.41 for stand-alone Prescription Drug plans (PDPs) and an average star rating of 3.46 for Medicare Advantage plans.



In 2012 34% of all rated stand-alone prescription drug plans had a star rating less than 3.00, whereas, only 16% of all 2013 stand-alone prescription drug plans had an summary star rating less than 3.00.  2013 Medicare Advantage plans saw a decrease in the number of plans falling under the 3.00 star rating benchmark.  2012 had 27% of all Medicare Advantage plans under the 3.00 star rating and 2013 saw only 13% of all MA plans under 3.00.

The star ratings are increasingly important as Medicare entices plans to increase plan quailty by having the special enrollment period for 5-star plans introduced in the 2012 plan year and the new special enrollment period for consistently low performing plans starting in the 2013 plan year.

The following chart show the change tendancy for the plan star ratings from 2012 to 2013.  For example, there were a total of 13 2011 plans with a 3-star rating.  Of those plans, five  plans' star rating remained unchanged from 2012 to 2013 (38%) and eight plans had an increase in their star rating.

You can see from the chart below, that a large percentage of plans from the lower star-rating categories saw an improvement in their quality ratings from 2012 to 2013.


Medicare Advantage plans showed a similar tendancy in star rating changes from 2012 to 2013 -- the lower rated 2012 plans had a tendency toward increasing their star rating as compared to the moderately rated plan.  As noted above, this could be due, in part, to the new special enrollment period for consistently low rated plans.  See chart below.


One note on the Medicare Advantage plan rating changes is the significant amount of plans that had a rating in 2012 however have insuficient data for a 2013 plan year star rating.  Also important is that two of the eight 5-star rated Medicare Advantage plans decreased in rating (H1365 fell to 3.5 stars and H9047 fell to 4.5 stars).