Explaining 5-Star Medicare Plans.

Medicare offerings are seemingly endless, with dozens of plan combinations, hundreds of providers, and thousands of doctors to choose from. To help recipients choose the best option, a third party federal agency, the United States Centers for Medicare and Medicaid Services (CMS), uses a rating scale to measure the value of various plans. Ratings range from 1 to 5 stars, and derive from more than 30 measurements in several categories. CMS star ratings are helpful tools to choose a medicare plan and provider, but it is important to understand what these ratings mean. With thorough research and help from a trusted medicare agent, recipients can confidently choose the best provider for their needs.


Understanding Medicare Ratings

People become eligible for a medicare advantage plan after enrolling in both Medicare Part A and Part B. Medicare advantage plans, often called Medicare Part C, cover nearly the same inpatient and outpatient services covered in original medicare, and offer special services like dental, vision, and hearing care. Recipients have a 7-month initial enrollment period for medicare, beginning three months before their 65th birthday and last until 3 months after. During this time they can choose their preferred advantage plan, including those with 5-star ratings.


Medicare providers are ranked from 1 to 5 stars, with 5 being the best available rating. CMS uses 35 metrics from several different categories to judge a group, mostly focusing on its prescription drug coverage, health benefits and available screenings, and overall member experience or customer service. Being that a company, carrier

Importance of the Medicare Rating

For every person who enrolls in a medicare advantage plan with a particular carrier, the U.S. government offers that carrier a specific dollar amount. Because the 5-star rating vouches for the quality of service, care options, drug coverage, and other benefits that a carrier provides, it attracts more clients to that plan and carrier. In turn, the government offers the group more money. It is mostly a win-win for the company and the people who utilize their services, because the company gets more funding to provide better services to its recipients!

The 5-star rating can be misleading though. Medicare plans are highly personalized to the individual receiving coverage. Their doctors, budgets, medical history, and care needs all determine which coverage company and plan they should utilize. For many people, the plan that best suits their needs may not have a 5-star rating.

For example, a company may receive a high rating because it offers a strong balance of customer service, prescription drug coverage, and other rating metrics. This same company may not have a strong dental coverage plan though. A patient with high dental costs should choose a carrier with strong dental coverage, even if that carrier has a lower CMS rating. An experienced medicare agent will help clients consider factors like this to determine which carrier is best for them.

5-star Special Enrollment Period

Anyone eligible for medicare plans are eligible for 5-star programs, and the enrollment process is the same as any lower ranked plan. Unlike most plans though, there is an open enrollment time frame for 5-star programs. With 5-star plans, a recipient can enroll at any time of the year, no matter their agreement with their current provider. Typically, medicare recipients must enroll during the short window near their birthday. People who are new to medicare services often take advantage of this as they determine which plan and provider is best for them. It is helpful to work with a medicare agent to know if switching plans is the best option, and how to do so.

Cost of a 5-star Rating

A 5-star rating does not impact how much the client pays for medicare coverage. No matter how a company or plan is rated, the end cost is exactly the same. The only difference will likely be the value of the care received for the price.

Determining the Medicare Rating

The 30+ metrics used to rate a medicare plan can be divided into 5 categories:

  • Customer Service: how employees interact with clients and respond to their needs, and how clients the overall experience with a company.
  • Chronic Condition Management: the availability of treatment options for long-term health conditions.
  • Preventive Action Support: access to services like screening tests, vaccines, and physical exams.
  • Member Satisfaction: how members feel about the overall coverage offered through a particular plan.
  • Carrier Responsiveness: the amount a plan improved when issues arose, and from year to year.

CMS finds the plan’s overall rating by averaging the score of each metric in each category. All the information aims to judge one main factor: the quality of the plan.

Enrolling in a 5-Star Medicare Advantage Plan

Choosing the best Medicare Advantage plan takes time, research, and commitment, but can drastically improve your health and lifestyle. Don’t take on this daunting task alone.

Agents with Sunnyside Medicare are licensed with dozens of providers nationwide and are highly trained in navigating the dense healthcare landscape. We work with you to learn your unique healthcare needs and match you to the right plan and right provider – no matter their ratings. Our team offers quality customer care, decades of insurance experience, and expert knowledge to serve you throughout your golden years. Plus, we work at no cost to you!

Sunnyside Medicare agents are ready to meet you today. Call us at 248-712-3863 or email

[email protected], and get on the Sunnyside today.


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Call us at 1-248-277-5948 to talk with a Sunnyside Agent. Our licensed Medicare Agents are friendly, knowledgeable and always willing to take the time to find the right plan for you! Not ready to talk on the phone? Send us an online message and an Agent will get back to you shortly. We look forward to helping you.

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