Every fall, the Centers for Medicare & Medicaid Services (CMS) publishes a quality score, from 1 to 5 stars, for every Medicare Advantage plan in the country. Those stars show up right next to each plan in Medicare’s comparison tools, but it isn’t always clear what they actually measure or how much weight they should carry in a decision. This guide breaks down how the rating system works, what changed for 2026, and how to use the stars alongside the rest of a plan comparison.
How the Star Rating System Works
CMS rates Medicare Advantage contracts, not individual plan brochures, on a scale of 1 to 5 stars in half-star increments. A single insurance company can offer several plans under one contract, so it’s worth checking which specific contract a plan falls under, since that’s the level at which the rating is actually calculated.
- Medicare Advantage plans with drug coverage (MA-PDs) are rated on up to 43 quality and performance measures
- Medicare Advantage plans without drug coverage are rated on up to 33 measures
- Standalone Part D drug plans are rated on up to 12 measures
The measures span several categories: preventive screenings and vaccines, how well a plan helps manage chronic conditions, member experience and satisfaction, member complaints and how quickly problems get resolved, and customer service responsiveness. For each measure, CMS sets thresholds called “cut points” that determine whether a contract’s performance earns one star or five. Those cut points are recalculated every year based on how all contracts performed, so a plan’s rating can shift even if its actual performance stayed the same.
What Changed for the 2026 Star Ratings
CMS published the 2026 Star Ratings on October 9, 2025. According to the CMS 2026 Star Ratings Fact Sheet, several methodology changes took effect this year:
- The weight given to patient experience, complaints, and access measures was cut from 4 down to 2, shifting more emphasis toward clinical outcomes
- A new measure, Kidney Health Evaluation for Patients with Diabetes, was added
- Two returning measures, Improving or Maintaining Physical Health and Improving or Maintaining Mental Health, came back after being revised, starting at a lower weight in 2026 before increasing in 2027
The practical result: the enrollment-weighted average star rating across all Medicare Advantage plans with drug coverage ticked up slightly to 3.98 in 2026, from 3.95 in 2025. About 40% of contracts (207 total) earned 4 stars or higher, and roughly 64% of MA-PD enrollees are in a plan rated 4 stars or above. Only 21 contracts nationwide earned the full 5 stars for 2026, 18 Medicare Advantage plans, one cost plan, and two standalone drug plans, making that top tier a genuinely small group. On the other end, CMS flagged 4 contracts with a low-performing icon for consistently weak ratings, down from 6 the year before.
One pattern worth knowing: non-profit plans tend to outperform for-profit plans. About 50% of non-profit Medicare Advantage contracts earned 4 stars or higher in 2026, compared to roughly 36% of for-profit contracts. Plans that have been in the Medicare Advantage program 10 years or more also trend toward higher ratings than newer entrants.
Why the Rating Matters Beyond a Marketing Number
Star ratings aren’t just a consumer comparison tool, they directly affect how much a plan gets paid. Contracts that reach 4 stars or higher qualify for Quality Bonus Payments from CMS, which add rebate dollars a plan can use to fund richer supplemental benefits, lower premiums, or reduced cost-sharing. A plan’s ability to offer extras like dental, vision, or a fitness program is often tied, at least in part, to how well it scored.
It’s also worth understanding the timing. The 2026 Star Ratings reflect care and service performance from an earlier measurement period, and they influence 2027 quality bonus payments. A high rating today is a look backward at care already delivered, not a guarantee about network access or service quality going forward. Ratings can and do change from year to year as cut points are recalculated and a plan’s own performance shifts.
The 5-Star Special Enrollment Period
Medicare gives people a way to act on a high rating outside the normal enrollment calendar. According to Medicare’s Special Enrollment Periods page, if a Medicare Advantage or Part D plan with a 5-star rating is available in a specific area, enrollees can use the 5-Star Special Enrollment Period (SEP) to switch into that plan one time between December 8 and November 30 of the following year.
- This SEP can only be used to move into a 5-star plan, not between two 5-star plans or out of one
- A separate SEP exists for people whose current plan has been rated below 3 stars for three consecutive years, allowing a switch to any plan rated 3 stars or higher at any point during the year
- Switching between plan types can affect prescription drug coverage; moving from a Medicare Advantage plan with drug coverage to a 5-star plan without it can result in a gap in Part D coverage
Because 5-star plans are only available in limited areas, checking availability by ZIP code on Medicare’s Plan Finder is the first step before assuming this option applies.
How to Use Star Ratings When Comparing Plans
Star ratings appear directly next to each plan on Medicare’s Plan Finder, alongside premiums, deductibles, and drug costs for a specific medication list. A few things are worth keeping in mind when factoring the rating into a decision:
- Look past the overall score to the category breakdowns. A plan can carry a solid overall rating while scoring lower on member complaints or a specific chronic disease measure that matters for a particular health situation
- Remember the rating applies to the contract, not to any one doctor or hospital in the network. A 5-star plan can still turn out to be the wrong fit if a preferred specialist isn’t in its network
- Weigh the rating alongside cost, network, and drug coverage rather than as a stand-alone deciding factor. A 3.5-star plan with the right network and lower drug costs may serve a specific person better than a 5-star plan that doesn’t cover their medications as well
For a full walkthrough of comparing plans, checking networks, and knowing which enrollment window applies, Senioridy’s guide to choosing and switching Medicare Advantage plans covers the process step by step.
Getting Help Comparing Plans
Star ratings give families a useful, CMS-verified starting point for judging plan quality, but they work best as one input among several rather than the only one. A plan’s cost structure, provider network, and drug formulary all deserve equal attention alongside the star score.
Families who want to dig into a specific contract’s rating history and measure-by-measure performance can find the underlying data on CMS’s Part C and D Performance Data page, the same source Medicare’s Plan Finder draws from.
For background on how Medicare Advantage compares to Original Medicare in the first place, see Senioridy’s Medicare Advantage vs. Original Medicare guide.
Ready to explore care options alongside your Medicare decision? Compare senior care options near you through Senioridy’s directory.
This article is for informational purposes only and does not constitute legal, financial, or medical advice. Medicare Advantage star ratings, measures, and methodology are set annually by CMS and are subject to change each year. For free, personalized Medicare guidance, contact your State Health Insurance Assistance Program (SHIP) counselor at shiphelp.org, available in every state at no cost. Always confirm current plan ratings and details directly with Medicare or the plan.