Medicare Advantage star ratings: how to read them

Medicare Advantage star ratings are yearly CMS scores for the quality of health and prescription drug services people receive in Medicare Advantage and Part D plans [1]. Each measure runs from 1 star to 5 stars, and the overall rating can also land on a half star [1][2]. A higher score is a useful quality signal. It is not a grade for your doctor in Greensboro, and it does not say whether your prescriptions are on that plan's drug list.

What Medicare Advantage star ratings measure

CMS publishes these ratings each year so people can see quality next to benefits and costs when they compare plans [1]. In the technical notes for the 2026 ratings, CMS says the quality and performance data are reported at the contract level, which is the agreement between Medicare and the organization that offers the plan [2]. Under the Code of Federal Regulations edition revised as of October 1, 2025, every plan benefit package under a Medicare Advantage contract carries the same overall rating, summary rating, or both, as that contract [7]. Data from those packages are generally combined to build the contract's measures [7]. Two options from the same organization can share a star rating even when the premium or the extras differ.

For the 2026 ratings, a Medicare Advantage contract with drug coverage is scored on up to 43 unique measures [1]. A Medicare Advantage contract without drug coverage is scored on up to 33 measures, and a stand-alone Part D plan on up to 12 [1]. CMS sets cut points that turn each result into one, two, three, four, or five stars, and it recalculates those cut points each year from performance in the measurement period [1].

Measures are grouped into domains. For 2026, the health-plan domains are staying healthy through screenings, tests, and vaccines; managing chronic conditions; member experience with the health plan; complaints and changes in the health plan's performance; and health plan customer service [2]. The drug-plan domains are drug plan customer service, complaints and changes in the drug plan's performance, member experience with the drug plan, and drug safety and accuracy of drug pricing [2]. Domain ratings are a simple average of the measures inside them. The Part C summary, the Part D summary, and the overall rating for a plan with both health and drug coverage are weighted averages [2].

The 2026 list includes breast cancer screening, colorectal cancer screening, blood sugar control, blood pressure control, getting appointments and care quickly, customer service, member ratings of the plan, complaints, members who leave, and timely decisions about appeals [3]. Drug measures include getting needed prescription drugs, drug-plan complaints, members who leave, adherence to medicines for diabetes, high blood pressure, and cholesterol, and the accuracy of posted drug prices [3]. Kidney Health Evaluation for Patients with Diabetes is a new measure for the 2026 ratings [1]. Improving or Maintaining Physical Health and Improving or Maintaining Mental Health returned for 2026 after a specification change, with a weight of 1 for 2026 and a weight of 3 beginning with the 2027 ratings [1].

Not every measure counts equally. In the 2026 ratings, improvement measures carry a weight of 5, many outcome and intermediate outcome measures carry a weight of 3, patient experience, complaints, and access measures carry a weight of 2, and many process measures carry a weight of 1 [3]. A weight of 3 counts three times as much as a weight of 1 in the summary and overall math [2]. Beginning with the 2026 ratings, CMS lowered the weight of patient experience, complaints, and access measures from 4 to 2 [1].

The October 1, 2025 regulation text says Part C measures reflect structure, process, and outcome, using clinical data, beneficiary experiences, changes in physical and mental health, benefit administration information, and CMS administrative data [7]. The 2026 technical notes also tie the data to member experience responses, the Health Outcomes Survey, HEDIS clinical measures, and required plan reporting [2]. The 2026 ratings use data primarily from measurement year 2024 [2]. When you look at stars during fall enrollment, you are mostly reading a look back, not a review of last week's visit.

How to read the 1-to-5 scale

At the measure and domain level, CMS uses whole stars [2]. In the 2026 technical notes, 5 means excellent, 4 means above average, 3 means average, 2 means below average, and 1 means poor [2]. CMS assigns half stars to the summary ratings and the overall rating so contracts can be told apart more finely [2]. You can see 3.5 or 4.5 overall even when a single measure is a whole star [2].

If a Medicare Advantage contract with drug coverage has only one of the two summary ratings, the overall line shows "Not enough data available" [2]. That is not the same thing as a poor rating. It means CMS did not have both pieces required for the overall score [2].

For the 2026 overall ratings, about 40% of Medicare Advantage contracts with drug coverage offered in 2026, which is 207 contracts, earned four stars or higher [1]. Weighted by enrollment, about 64% of people in those contracts were in a contract with four or more stars [1]. The enrollment-weighted average overall rating was 3.98, and 18 of 516 rated contracts sat at 5 stars [1]. CMS also says year-to-year changes are normal, because the ratings capture one measurement period and the cut points move [1].

What the stars do not say about your doctors

The measures above do not name a physician, a clinic, or a hospital in Greensboro or anywhere else in the Piedmont [3]. They describe contract-wide results on screenings, chronic-condition care, member experience, complaints, customer service, and appeals [3].

Doctor access is a separate question. The 2027 Medicare & You handbook says that with Medicare Advantage you may need to use doctors and other providers in the plan's network and service area for non-emergency care, and that some plans cover non-emergency care out of network at a higher cost [6]. The handbook also says you may need approval before the plan covers certain services [6]. None of that is inside the star. Before we treat a star as a reason to move a parent, our team wants the office confirmed.

What the stars do not say about your prescriptions

A strong drug rating is not a promise that the bottles at home are covered. Medicare says to review the formulary, the plan's drug list, before you join, and to check whether it covers the drugs you take [5]. Each list includes at least two drugs in the most commonly prescribed categories and classes, but the plan chooses which drugs to offer [5]. A specific drug might be missing even when a similar drug is covered [5]. If you and your prescriber believe none of the covered drugs will work, you can ask for an exception, and the prescriber must give a medical reason [5].

Plans may change the drug list during the year when therapies change, new drugs come out, or new medical information becomes available [5]. Plans must include most drugs in protected classes: cancer drugs, HIV/AIDS drugs, antidepressants, antipsychotics, anticonvulsants, and immunosuppressants for organ transplants [5]. "Most drugs" in a protected class is not the same thing as your exact brand, at your pharmacy, on the tier you hope for.

The 2026 Part D measures look at getting needed prescription drugs, complaints, members who leave, adherence to diabetes, blood pressure, and cholesterol medicines, and posted price accuracy [3]. Adherence asks whether members with those conditions fill those classes of medicine as the measure defines it [3]. It does not open your medicine cabinet. Checking doctors, the pharmacy, and the medicines is separate work, and it is the work we describe on our Medicare Advantage (MAPD) page.

What a high star can mean for the plan's payment

Stars also affect what Medicare pays the plan. That is separate from your copay. The 2026 ratings were published on Medicare Plan Finder on October 9, 2025, and CMS said they will affect 2027 Medicare Advantage quality bonus payments [1]. The 2027 Medicare & You handbook tells people to start comparing current coverage with 2027 options on October 1, 2026 [6]. If you are comparing plans in that later season, read the rating year on the screen. The average of 3.98, the 207 contracts at four stars or higher, and the other 2026 figures in this article describe the October 2025 release [1].

In the Code of Federal Regulations edition revised as of October 1, 2025, Medicare Advantage payment uses a 5-star quality rating at the plan or contract level [8]. Beginning with 2012, a qualifying plan is one with a quality rating of 4 stars or higher on the most recent data for that year [8]. For 2014 and later years, that status increases the applicable percentage in the payment benchmark by 5.0 percentage points [8]. In a county that meets the extra tests in that same rule, the increase is doubled [8].

Read that as a payment rule for the organization. It does not put your doctor or your drug on the plan, and it does not promise you a lower premium. Extra benefits, when a plan offers them, live in the benefit package. They are not printed inside the star.

When the stars can change your chance to switch

If a Medicare Advantage plan, Medicare drug plan, or Medicare Cost Plan with a 5-star rating is available where you live, you can use the 5-star Special Enrollment Period to move from your current Medicare plan to that 5-star plan [4]. Medicare says you can use this chance only once between December 8 and November 30 of the following year [4]. The 2027 handbook describes the same window, the same once-only limit, and the same 1-to-5 scale for comparing quality and performance [6].

Look at drug coverage before you move. If you leave a Medicare Advantage plan that includes drugs for a 5-star Medicare Advantage plan that does not, you may lose prescription drug coverage, wait for another chance to get it, and owe a Part D late enrollment penalty [4]. If you leave a Medicare Advantage plan with drugs for a stand-alone 5-star drug plan, you also leave the health coverage and return to Original Medicare for health services, and only if that 5-star drug plan is offered where you live [4].

On the low end, if your plan has had a star rating of less than 3 stars for the last 3 years, Medicare says you can switch to another Medicare Advantage plan or Medicare drug plan at any time you remain in that low-performing plan [4]. CMS also posts a low performing icon. For the 2026 ratings, the icon applies when the Part C summary, the Part D summary, or both were 2.5 stars or lower in the 2024, 2025, and 2026 ratings, and the contract had a Part C or Part D rating in each of those three years [2]. Four Medicare Advantage contracts with drug coverage carried that icon for 2026 [1]. A 5-star plan that misses your specialist, or a move that drops a medicine, can cost more trouble than the star was worth.

A note for North Carolina families

For the 2026 ratings, CMS listed Hurricane/Tropical Storm Helene in North Carolina, along with storms in other states, among the qualifying extreme and uncontrollable circumstances for the 2024 performance period [1]. That note is about how the rating rules treat contracts touched by a declared disaster. It is not a star for Guilford County, Greensboro, or a parent's physician. The 2026 enrollment-weighted average of 3.98 cannot tell you whether a plan in your ZIP code includes the clinic you already trust [1].

Practical takeaways

• Read the overall rating and, when both are shown, the Part C and Part D summaries, because the overall number blends health and drug measures [2].
• On a single measure, 5 means excellent and 1 means poor. Summary and overall ratings can sit on a half star, such as 3.5 or 4.5 [2].
• In the 2026 ratings, about 64% of people enrolled in Medicare Advantage drug contracts were in a contract with four or more stars, while 18 of 516 rated contracts had 5 stars [1].
• The stars do not name your doctor or confirm your drug list. Review the formulary before you join, and remember that Medicare Advantage may require network providers for non-emergency care [5][6].
• The 2026 figures here describe the ratings CMS published on October 9, 2025 [1]. CMS posts a new set each year, so check the rating year before you rely on a number [1].
• A 5-star plan where you live can open a once-only switch between December 8 and November 30 of the following year [4]. A plan under 3 stars for the last 3 years can be left while you are still in it [4].
• Before you switch for the stars alone, confirm the new plan still covers your prescriptions. Leaving drug coverage behind can mean a wait and a late enrollment penalty [4].

How we can help

Have more questions or want to get in touch?

Our team at Seniors Insurance Hub sits with seniors and adult children across Greensboro and the Piedmont and reads these scores next to the items the stars leave out: the doctors, the pharmacy, and the medicines in the house. If you want to talk through a Medicare Advantage plan that includes drug coverage, start with our Medicare Advantage (MAPD) page, or reach us on our contact page.

You can call us at (336) 937-7501.

Citations

1. Centers for Medicare & Medicaid Services, "2026 Medicare Advantage and Part D Star Ratings" (2025-11-18)
2. Centers for Medicare & Medicaid Services, "2026 Part C & D Star Ratings Technical Notes" (2025-09-25)
3. Centers for Medicare & Medicaid Services, "2026 Star Ratings Measures and Weights" (2026)
4. Medicare.gov, "Special Enrollment Periods" (2026)
5. Medicare.gov, "How do drug plans work?" (2026)
6. Medicare.gov, "Medicare & You 2027" (2026)
7. U.S. Government Publishing Office, "42 CFR 422.162, Code of Federal Regulations, edition revised as of October 1, 2025" (2025-10-01)
8. U.S. Government Publishing Office, "42 CFR 422.258, Code of Federal Regulations, edition revised as of October 1, 2025" (2025-10-01)