Medicare Star Ratings help beneficiaries and insurance agents compare the quality and performance of Medicare Advantage and Medicare Part D plans.
The Centers for Medicare & Medicaid Services assigns ratings annually on a scale from one to five stars. A higher rating generally reflects stronger performance across the measures CMS evaluates, but it does not automatically make a plan the best choice for every client.
Agents should use Star Ratings as one part of a complete plan comparison alongside:
Understanding what the ratings measure—and what they do not measure—can help agents educate clients, set accurate expectations, and make more defensible recommendations.
CMS assigns Star Ratings to eligible:
Ratings range from one to five stars:
| Rating | CMS performance category |
|---|---|
| 5 stars | Excellent |
| 4 stars | Above average |
| 3 stars | Average |
| 2 stars | Below average |
| 1 star | Poor |
CMS publishes updated ratings each fall for the upcoming plan year. Ratings can change annually as plan performance, quality measures, methodology, cut points, and available data change.
Agents should always verify the rating for the applicable contract year. Do not rely on a prior-year brochure, saved screenshot, or a carrier’s historical reputation.
Medicare Star Ratings combine multiple measures intended to reflect health care quality, member experience, customer service, access, and prescription drug plan performance.
The exact number and weighting of measures can change by year and plan type. For 2026, CMS rates Medicare Advantage Prescription Drug contracts on up to 43 measures, Medicare Advantage-only contracts on up to 33 measures, and standalone Part D contracts on up to 12 measures.
Measures fall into broad categories such as:
Specific measures may examine areas such as:
CMS can add, remove, revise, or reweight measures. A rating change may therefore reflect both plan performance and changes to the ratings methodology.
Agents should distinguish a plan’s overall Star Rating from its scores on individual measures or categories.
A plan may have:
Do not describe a plan as “5-star” because it received five stars on one measure. The term should refer to the plan’s official overall rating when discussing plan quality or enrollment implications.
When helping a client compare plans, review the overall rating and relevant underlying categories when that information is available.
Star Ratings give beneficiaries a standardized way to compare certain aspects of plan performance.
A client may use the rating to ask better questions, such as:
The rating can narrow a comparison, but it does not reveal whether the plan includes a client’s doctors or prescriptions.
It also does not show the complete financial impact of joining the plan.
A Star Rating does not automatically tell a client:
A plan with a lower Star Rating may fit a client better than a higher-rated plan because of provider access, prescription coverage, costs, or plan structure.
Agents should never let the rating replace a complete needs analysis.
A higher overall rating indicates stronger performance under CMS’s current measurement system. It does not establish that the plan is universally better.
For example, compare two hypothetical Medicare Advantage Prescription Drug plans:
| Comparison factor | Plan A | Plan B |
|---|---|---|
| Overall Star Rating | 4.5 stars | 3.5 stars |
| Client’s primary doctor | Out of network | In network |
| Preferred specialist | Out of network | In network |
| Important prescription | Not on formulary | Tier 2 |
| Monthly premium | $20 | $0 |
| Specialist copay | $50 | $30 |
| In-network maximum out of pocket | $7,500 | $5,500 |
| Dental allowance | Higher | Lower |
Plan A has the stronger overall rating and a larger dental benefit. Plan B may still be more suitable because it covers the client’s doctors and prescription and offers lower potential medical costs.
The Star Rating informs the decision. It does not make the decision.
Before discussing ratings, identify the client’s priorities:
This creates the standard against which every plan should be evaluated.
A highly rated plan should not remain under consideration when it fails a critical requirement.
Remove or carefully reconsider plans that:
Once the unsuitable options have been removed, use Star Ratings to compare the remaining plans.
A stronger rating may help distinguish between plans that otherwise meet the client’s needs.
Consider:
A useful explanation might sound like this:
“Medicare gives this plan an overall rating based on quality, member experience, customer service, complaints, and other measures. The rating is helpful, but we should also verify your doctors, prescriptions, costs, and the plan rules before deciding.”
This keeps the rating meaningful without overstating it.
Record:
Documentation helps demonstrate that the recommendation was based on the client’s needs rather than a single plan characteristic.
Clients may become concerned when their plan’s rating declines.
A lower rating does not automatically mean:
The agent should review what actually changed.
A rating decline could reflect:
Agents should then separately review the plan’s Annual Notice of Change, provider network, formulary, premiums, cost sharing, and benefits for the upcoming year.
PSM’s analysis of why Medicare Advantage Star Ratings fell for 2026 explains how methodology changes can affect ratings and why agents should avoid oversimplifying year-over-year movement.
Star Ratings are not only a consumer-comparison tool. They can also affect Medicare Advantage plan finances.
Medicare Advantage contracts that meet applicable quality thresholds may qualify for Quality Bonus Program payments. Ratings can also affect rebate calculations and how plans compete in local markets.
Those financial effects may influence a plan’s ability to fund:
However, agents should not claim that a particular rating guarantees a particular benefit.
A plan can change premiums, cost sharing, networks, formularies, or supplemental benefits for many reasons. Agents should rely on current plan documents rather than predicting future benefits from the Star Rating alone.
For a closer look at the current market, review PSM’s 2026 Medicare Advantage Star Ratings takeaways.
A strong Star Rating can help support a client conversation, but higher-rated plans are not automatically easier to sell.
An agent may find a higher-rated plan difficult to recommend when it:
Conversely, a client may be satisfied with a lower-rated plan that meets their most important needs.
Agents should not use Star Ratings as a shortcut for suitability. The strongest sales process begins with the client’s priorities and uses ratings as supporting evidence.
Higher ratings may indicate stronger performance in areas related to member experience, complaints, service, and quality. However, a high rating does not guarantee that an individual client will remain satisfied.
Retention can depend on:
A well-matched plan and year-round service are more reliable retention strategies than choosing a plan based on its rating alone.
Agents can support retention by:
Agents should avoid describing lower-rated plans as “bad plans.”
A lower overall rating means the plan performed less strongly under CMS’s measurement system for that year. It does not tell the entire story for every member.
A balanced explanation could be:
“This plan has a lower overall Medicare rating than some alternatives. Let’s look at the areas contributing to that score and compare them with the factors most important to you, including your doctors, prescriptions, costs, and benefits.”
This approach gives the client useful information without creating unnecessary fear.
Agents should also avoid telling clients they need to change plans solely because a rating declined.
Medicare may identify certain contracts with a low-performing icon when they receive fewer than three stars for three consecutive years.
This warning is different from a plan simply receiving a rating below three stars for one year.
Clients enrolled in a consistently low-performing plan may have access to a Special Enrollment Period under applicable Medicare rules. Agents should verify current eligibility and enrollment guidance before recommending a change.
Do not assume that every plan below three stars automatically triggers the SEP.
A plan with an overall rating of five stars has earned CMS’s highest performance designation.
When an eligible 5-star Medicare Advantage, Medicare Cost, or standalone Part D plan is available in a beneficiary’s service area, the beneficiary may have access to the 5-star Special Enrollment Period.
That enrollment opportunity has specific timing, eligibility, destination-plan, and coverage-transition rules. It should not be described as unlimited year-round enrollment.
Because the 5-star SEP requires a separate discussion of election periods, drug coverage, Original Medicare, and plan transitions, agents should review dedicated current guidance before using it.
Avoid reading technical measure names without explaining why they matter.
Connect the rating to familiar questions:
Use current Medicare Plan Finder information and approved quoting tools.
Explain:
A visual comparison can help clients understand the relationship between ratings and practical coverage.
Include:
Do not tell a client that a higher-rated plan will necessarily save money.
Instead, compare actual costs:
A lower-rated plan may be less expensive for one client and more expensive for another.
Agents may reference official Medicare Star Ratings in marketing when permitted by current CMS and carrier requirements.
Marketing should:
Agents should verify carrier review requirements before creating advertisements, social posts, emails, event materials, or webpages that reference a plan’s rating.
PSM’s guide to Medicare marketing rules provides additional compliance considerations for agent outreach.
Star Ratings do not replace provider, prescription, cost, network, or benefit verification.
The plan must fit the individual client.
A rating summarizes performance under the CMS methodology. It does not determine suitability for every beneficiary.
Ratings are updated annually. Always identify the applicable plan year.
A plan may receive five stars in one area without having an overall five-star rating.
The rating can reflect quality performance, but an agent should not promise an individual medical outcome.
Star Ratings and client costs are separate comparison factors.
Measure weights, specifications, cut points, and included measures can change.
Plan-specific marketing may require approved materials and review.
Review the full plan and the client’s needs before recommending any enrollment action.
Agents can use these questions during plan comparisons:
Medicare Plan Finder displays current plan availability, costs, benefits, formularies, and Star Ratings by location.
Use the client’s correct ZIP code, county, prescriptions, pharmacies, and coverage information.
Agent-facing platforms can help compare plans, but agents should confirm:
CMS publishes Star Ratings fact sheets, technical notes, measure data, cut points, and other performance resources.
These materials are useful when an agent needs more detail than Medicare Plan Finder provides.
Agents can explore PSM’s Medicare agent resources for quoting, enrollment, education, and business-development support.
PSM Brokerage supports independent insurance agents with resources that may help them compare, explain, and market Medicare plans responsibly.
Support may include:
Agents can explore PSM’s Medicare products and resources, review insurance agent training, or access the PSM Marketing Hub.
Medicare Star Ratings give agents and beneficiaries a standardized way to compare aspects of Medicare Advantage and Part D plan quality and performance.
They can provide useful information about:
But they do not show whether a plan includes the client’s doctors, covers their prescriptions, fits their budget, or provides the most suitable benefits.
Use Star Ratings to strengthen a plan comparison—not replace one.
A responsible agent starts with the client’s needs, verifies the complete plan, explains the rating in context, and documents why the selected option is appropriate.
PSM Brokerage supports independent agents with Medicare carrier access, contracting, certifications, compliance guidance, enrollment technology, training, marketing resources, and experienced account support.
View PSM’s Medicare agent resources or get contracted with PSM Brokerage to learn more.
Centers for Medicare & Medicaid Services: 2026 Medicare Advantage and Part D Star Ratings Explains the 2026 Star Ratings methodology, measure categories, contract-rating distribution, and changes affecting Medicare Advantage and Part D plans.
Centers for Medicare & Medicaid Services: Part C and Part D Performance Data Provides current Star Ratings fact sheets, technical notes, measure data, cut points, and downloadable performance files.
Medicare.gov: Medicare Plan Finder Allows agents and beneficiaries to compare available Medicare Advantage and Part D plans, including current costs, benefits, formularies, and Star Ratings.
Centers for Medicare & Medicaid Services: Medicare Advantage and Part D Star Ratings Data Provides the official performance data used to understand annual plan ratings and individual quality measures.
For licensed insurance agent education only. This article is not legal or compliance advice and does not replace current CMS, Medicare, carrier, plan, state, or enrollment-platform guidance. Star Ratings, measures, methodology, plan availability, benefits, networks, formularies, and enrollment rules may change. Verify current plan-specific information before marketing or recommending coverage.