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How does Medicare Star Quality Ratings work?

Each Medicare health plan earns an overall rating from 5 Stars to 1 Star. The ratings are updated annually based on ongoing monitoring and analysis.

★★★★★ Excellent performance

     ★★★★ Above average performance

          ★★★ Average performance

               ★★ Below average performance

                     Poor performance

            

Who created Medicare Star Quality Ratings?

The rating system is developed by the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers Medicare. It provides Medicare beneficiaries with a way to assess Medicare Advantage (MA) health plans based on quality of care and service delivery.

The system is based on measures spanning these 5 categories:

  • Outcomes measures that focus on improvements to a beneficiary's health from the care provided
  • Intermediate outcomes measures that contribute to the outcome measures above
  • Patient experience measures represent beneficiaries' perspectives about the care they’ve received
  • Access measures reflect issues that may create barriers to receiving care
  • Process measures that capture the ways health care is provided
            

What do Medicare Star Quality Ratings assess?

Medicare health plan performance is measured based on major categories that include:

  • Preventive care
  • Chronic care
  • Prescription drug services
  • Customer service
  • Member satisfaction

In California, Hawaii, and Washington, Kaiser Permanente is an HMO plan with a Medicare contract. In Colorado, Oregon, Southwest Washington, Georgia, Maryland, Virginia and the District of Columbia, Kaiser Permanente is an HMO and HMO-POS plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal.

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This page was last updated: October 21, 2022 at 12:00 a.m. PT