A Guide to 5 Star Medicare Plans
March 25, 2019
Reviewed and Updated by Kelsey Davis,
There are 2,734 Medicare Advantage (MA) plans on the market nationwide in 2019. This is an increase of 417 plans since 2018! Based on location and eligibility, the average enrollee has 24 plan options, but only 10 percent of beneficiaries are enrolled in 5 star Medicare plans. These star ratings can help you understand the quality of services and care within the plan.
What is a Medicare 5 star rating?
Medicare has four main parts (A, B, C, and D), but not every part is rated. The Centers for Medicare and Medicaid Services (CMS) uses a rating system to rate Medicare Advantage and Part D plans. The rating system is as follows:
- Five stars: Excellent
- Four stars: Above average
- Three stars: Average
- Two stars: Below Average
- One star: Poor
Medicare Advantage and Part D may have the same star system, but they have different factors that are weighted in the rating process. This is because they have primarily different purposes.
MA plans can provide additional benefits beyond Original Medicare like hearing, vision, or dental coverage. On the other hand, Part D plans provide prescription drug coverage.
Medicare Advantage plans are rated on the following factors:
- Level of access to preventive services (including annual physical exams and screenings)
- Care coordination
- How often members receive treatment for long-term conditions
- Current member satisfaction
- Plan performance in comparison to the previous year
- Customer service quality
Part D plans are rated on the following:
- Number of member issues with the plan
- How many people left over one year
- Patient safety while using prescriptions in the plan
- Accuracy of pricing
- Quality of care
- Customer service quality
What is a 5 star Medicare plan?
A 5 star plan is a plan with a 5 star rating! Rating information is released annually in October. You can review the ratings and compare plans here.
If a plan receives a rating below three stars for three consecutive years, it will be flagged by CMS. If the plan continues to rate poorly, it may be removed entirely from the marketplace.
This ensures that you are given the best plan options when you are enrolling. In 2019, most beneficiaries can enroll in a Medicare Advantage or Part D plan with four or more stars.
Are 5 Star Medicare Advantage Plans PPOs or HMOs?
Many Medicare Advantage carriers offer both PPOs (preferred provider organizations) and HMOs (health maintenance organizations). Both options provide top-quality healthcare services, but there are some differences:
- HMO: With a HMO, you will need to select a primary care provider (PCP). Your PCP will need to make a referral in order for you to see a specialist.
- PPO: You will not need to select a PCP with a PPO, nor do you need a referral to see a specialist in most cases.
The key difference that may help many people choose an option is cost. HMOs typically have lower monthly premiums than PPOs.
A licensed agent with Medicare Plan Finder can help you determine which type of plan is best for you. Our agents are highly trained and they can discuss the benefits of the plans in your area so you can make an informed decision.
5 Star Medicare Advantage and Part D Plan Carriers
5 Star Medicare Advantage plan (and Part D plan) carriers include:
- Anthem
- Cigna
- Humana
Please note, ratings change annually, and each specific plan can have a different rating. We can not guarantee placement in a top-rated Medicare plan and this list is subject to change.
When can you enroll in a 5 star plan?
Several enrollment periods allow you to enroll in a Medicare Advantage plan, but did you know there is an enrollment period specific for 5 star plans?
5 Star Medicare Plans Special Enrollment
If you do not currently have top-rated Medicare Advantage plans available in your zip code, and a new plan becomes available, you can switch from your current plan to a 5 star plan even if it is not the Annual Enrollment Period. This means that you have a Special Enrollment Period. This enrollment period lasts from December 8 to November 20 of the following year. During this time you can:
- Switch from Original Medicare to a 5 star plan
- Change from a lower-rated plan to a 5 star plan
- Switch between different 5 star plans
How to Find 5 Star Medicare Advantage Plans Near You
Are you looking for top-rated Medicare plans near you? Our licensed agents can answer any questions about how to enroll, when you can switch, and plans that are available to you.
Interested in arranging an appointment? There is no cost to you and never an obligation to enroll. Fill out this form or call us at 844-431-1832.
