Medicare Advantage star ratings: what they mean when you’re picking a plan

Short answer

Each fall, CMS assigns every Medicare Advantage plan a star rating from 1 (poor) to 5 (excellent). The rating summarizes performance across 40 measures grouped into five domains: staying healthy, managing chronic conditions, member experience, complaints, and customer service. The ratings are published on Medicare.gov and used to compare plans during Annual Enrollment. They also affect how much CMS pays each plan.

What are Medicare Advantage star ratings?

CMS runs the star ratings program to measure Medicare Advantage plan quality on a comparable, public scale. Every year in October, CMS publishes updated ratings for every Medicare Advantage contract — one overall rating from 1 to 5, plus underlying scores on each of the five domains.

The ratings do two things. They give consumers a shopping signal during the Annual Enrollment Period. They also affect how much CMS pays the plan — higher-rated plans receive Quality Bonus Payments that increase their revenue and often subsidize richer benefits for enrollees. For the foundational comparison between Medicare Advantage and Original Medicare — the frame in which star ratings live — see our Medicare Advantage vs Medicare guide.

You will see star ratings on Medicare.gov Plan Finder next to every Medicare Advantage plan available in your ZIP code. They are also on CMS’s Part C and D Performance Data page for historical comparison.

The five domains explained in plain English

CMS groups its 40 measures into five performance domains. Each domain focuses on a different aspect of how a plan serves its members.

Staying healthy — screenings and preventive care

Measures track whether the plan is doing routine screenings and preventive care — cancer screenings, flu shots, annual wellness visits, blood pressure control. This domain rewards plans that keep members healthy before problems escalate.

Managing chronic conditions

Measures track how well the plan supports members who have ongoing conditions — diabetes A1C control, medication adherence for cardiovascular disease, follow-up after hospital stays, coordination of specialist care. If you have a chronic condition, this domain matters most for you.

Member experience

Measures come from a survey of members about their care — how easy it is to get needed services, how easily they can see specialists, how well the plan handled coordination. These measures carry heavier weight (4× multiplier) than most process measures, because CMS treats direct member feedback as the most reliable signal of plan quality.

Complaints and quality-of-care changes

Measures track member complaints filed with CMS (per 1,000 enrollees) and quality-of-care changes over time. Higher complaint volume drives down the score.

Customer service

Measures track how well the plan’s own customer service performs — appeal decision timeliness, foreign-language interpretation, complaint handling, call-center responsiveness.

What changed for 2026

CMS updated the 2026 methodology in three ways that most affect plan performance.

Tukey outlier deletion — what it means for you

CMS now applies a statistical technique called Tukey outer-fence outlier deletion to the cut-point calculations that decide star levels. Plans in extreme performance tails (very high or very low) are excluded from the calculation of where cut-points fall. The intent is to reduce year-over-year rating swings driven by a single outlier plan skewing the whole distribution.

For consumers, this means star ratings should be more stable year to year — a plan that earns 4 stars this year is more likely to earn 4 stars next year (or 3.5 or 4.5) rather than swinging dramatically because one competitor performed atypically.

Why patient-experience measures dominate the score

CMS continues to weight member-experience and complaint measures at 4× the weight of process/effectiveness measures (which are weighted 1× to 3×). This means how members rate their plan’s service and how many complaints CMS receives about the plan drive a disproportionately large share of the overall star rating.

If a plan scores well on member experience and low on complaints, it can offset weaker performance on some process measures. The reverse is also true — poor member experience is hard to recover from with strong process scores.

New measures that matter if you have chronic conditions

CMS phased in two new measures for 2026:

• Kidney health evaluation for patients with diabetes (KED) — tracks whether the plan is screening diabetes patients for kidney disease at the recommended interval.
• Follow-up after emergency department visit for people with multiple chronic conditions (FMC) — tracks whether the plan is coordinating follow-up care after ED visits for medically complex members.

If you have diabetes or multiple chronic conditions, these new measures give you a way to check whether the plan is actually managing your specific care pattern well.

How to actually use star ratings when picking a plan

Star ratings are a signal, not a verdict. Here is how to use them without getting fooled. If you want to combine star ratings with four other evaluation checks (network breadth, out-of-pocket max, prior-authorization denial rate, complaint volume), our five red flags framework puts star ratings in the wider evaluation context.

Rule 1 — Filter below 3.5 stars

Screen out anything below 3.5 stars. CMS itself designates plans below this line as “low performers” and publishes warning letters to the plan. Under-3.5 plans are worth avoiding unless there is a very specific reason (an SNP you qualify for, a plan uniquely available for your condition).

Rule 2 — Look at the domain that matches your needs

The overall star rating is an average. Underlying domain scores tell you where the plan is strong and where it is weak. If you have diabetes, look at the plan’s chronic-condition domain, not just the overall. If you rely heavily on customer service to navigate coverage, look at that domain specifically. A 4-star plan with a 3-star chronic-condition domain is worse for you (if you have chronic conditions) than a 3.5-star plan with a 4.5-star chronic-condition domain.

Rule 3 — Read the trend, not just this year’s number

A 4-star plan trending down (was 4.5 two years ago, is 4 today) is worth less than a 3.5-star plan trending up (was 3 two years ago, is 3.5 today). Trend direction usually predicts next year’s score better than this year’s score alone. Trend data is available on the CMS Part C and D Performance Data page.

Rule 4 — Cross-check with complaint data on Medicare.gov

Star ratings summarize complaint data into a domain score. The raw complaint ratio (complaints per 1,000 enrollees) is published in the same CMS data set that generates the star ratings. Two plans with the same domain score can have very different complaint volumes when you look at the raw numbers. Cross-check.

What star ratings do not tell you

Star ratings measure plan performance in aggregate. They do not measure:

• Whether your specific doctor is in-network.
• Whether your specific medication is covered on the plan’s formulary.
• Whether the plan’s prior-authorization rules will delay your specific care.
• Whether the plan’s network extends to any state you travel to.

A 5-star plan that doesn’t include your cardiologist is worse for you than a 3.5-star plan that does. Use star ratings as a filter, then check the plan against your provider list, your medication list, your travel pattern, and your specific care needs — a patient advocate can run each of those checks against every plan on your shortlist.

The 5-Star Special Enrollment Period

Any Medicare beneficiary can switch into a 5-star Medicare Advantage plan once per calendar year, outside of Annual Enrollment. This is a Special Enrollment Period built into the star ratings program to reward high-performing plans and give consumers year-round access to them.

If a 5-star plan is offered in your ZIP code — availability varies by county — you have the flexibility to move to it at any time. You cannot use this Special Enrollment Period to switch between 4.5-star plans or into a plan below 5 stars; it is specifically for 5-star access.

Frequently asked questions

Are 2026 Medicare Advantage star ratings out yet?

CMS publishes updated star ratings each October for the following plan year. Ratings for the 2026 plan year were released in October 2025 and are viewable on Medicare.gov Plan Finder and the CMS Part C and D Performance Data page. Ratings for the 2027 plan year will publish in October 2026.

What is a 5-star Medicare Advantage plan?

A plan that earned the highest overall star rating in CMS’s most recent October release. 5-star plans qualify for the Quality Bonus Payment program (higher CMS payments), and any Medicare beneficiary can switch into a 5-star plan once per calendar year outside of Annual Enrollment.

How often do star ratings change?

Every October. CMS publishes updated ratings for every Medicare Advantage contract based on measures from the prior measurement year. A plan’s rating can shift up or down depending on how its performance changed and how it compares to peers.

Can I switch to a 5-star plan outside of Annual Enrollment?

Yes. The 5-Star Special Enrollment Period lets any Medicare beneficiary switch into an available 5-star plan once per calendar year. You cannot use this SEP to move between plans below 5 stars; it is specifically for 5-star access.

How does CMS calculate the overall star rating?

CMS scores each of about 40 measures separately (each measure produces a 1-to-5 star score). Measures are grouped into the five domains. Domain scores are combined into the overall star rating using a weighting formula where member experience and complaint measures carry 4× the weight of most process measures. Tukey outlier deletion is applied to the cut-point calculations to reduce year-over-year swings.

This information is for educational purposes and should not substitute for professional guidance. Healthcare coverage details vary by individual plan. Consult with Baba’s support team or your insurance provider for information specific to your situation.