Introduction
Every fall, the Centers for Medicare & Medicaid Services (CMS) releases updated Star Ratings for Medicare Advantage and Part D plans. These 1-to-5 star scores help you gauge plan quality and member experience before you commit to a year of coverage.
Here's the catch: a 5-star plan that doesn't include your cardiologist or cover your insulin isn't a good plan for you. Many people assume a higher rating automatically means better coverage for their specific situation. It doesn't.
This guide walks through what the 2026 ratings actually measure and what changed this year. You'll also see how to weigh those scores against your doctors, prescriptions, pharmacies, and budget so you can choose coverage that fits your life.
Key Takeaways
- Star Ratings score MA and Part D plans from 1 (poor) to 5 (excellent) using CMS’s annual quality measures.
- Medicare Advantage and Part D use different measure sets, so check the rating that applies to your specific coverage.
- Medicare Plan Finder lists each plan’s 2026 Star Rating plus premiums, network, formulary, and estimated costs.
- Use a strong rating to shortlist plans—then still compare your doctors, drugs, pharmacies, and total costs.
What Are Medicare Advantage and Part D Star Ratings?
CMS uses Star Ratings as an annual, standardized 1-to-5 scale to measure the quality of Medicare Advantage plans and Medicare Part D prescription drug plans. The system exists to give beneficiaries a quick quality snapshot before enrollment.
The scale breaks down like this:
| Stars | CMS Rating |
|---|---|
| 5 | Excellent |
| 4 | Above Average |
| 3 | Average |
| 2 | Below Average |
| 1 | Poor |
CMS allows half-star increments for overall and summary ratings, so you'll frequently see plans rated 3.5 or 4.5 rather than a clean whole number, according to CMS's 2026 Star Ratings technical notes.
Three Ratings, Not One
This is where a lot of confusion starts. Depending on the plan type, you might see:
- A Part C rating — for Medicare Advantage plans without drug coverage
- A Part D rating — for stand-alone prescription drug plans
- An overall rating — for Medicare Advantage-Prescription Drug (MA-PD) plans that bundle medical and drug coverage, calculated from weighted Part C and Part D measures
An MA-PD's overall score isn't a simple average of its two summary ratings. Two measures—complaints and members leaving the plan—get counted only once in that blended calculation. Treat the three ratings as related but distinct, not interchangeable.
What Do the 2026 Star Ratings Measure?
Medicare Advantage-only contracts can be scored on up to 33 measures across five domains. Stand-alone Part D plans have up to 12 measures across four domains. MA-PD plans combine up to 43 unique measures from both.
Medicare Advantage Measurement Areas
| Domain | Sample measures |
|---|---|
| Staying Healthy: Screenings, Tests and Vaccines | Breast cancer screening, colorectal screening, flu vaccine |
| Managing Chronic Conditions | Blood sugar control, blood pressure control, kidney health evaluation for diabetes |
| Member Experience | Getting needed care, getting appointments quickly, care coordination |
| Complaints and Plan Performance Changes | Complaints, members leaving the plan, quality improvement |
| Customer Service | Timely appeals decisions, interpreter and TTY availability |
Part D Measurement Areas
Part D measures focus on different areas: customer service, complaint volume, member satisfaction, and drug safety.
Key examples include:
- Medicare Plan Finder price accuracy
- Medication adherence for diabetes and hypertension drugs
- Comprehensive medication review completion rates
Why does this matter for you? A plan can score well on preventive screenings but weaker on customer service, or vice versa. If prescription safety or appeals handling matters most to you, don't stop at the overall star number. Drill into the specific domain.
What Changed for 2026
CMS doesn't freeze this methodology in place year over year. For 2026, the agency:
- Cut the weight of patient experience, complaints, and access measures from 4 down to 2
- Added a new Kidney Health Evaluation for Patients with Diabetes measure
- Reintroduced Improving or Maintaining Physical Health and Improving or Maintaining Mental Health after specification changes (weight 1 in 2026, rising to 3 in 2027)
That means a 2026 rating isn't calculated the same way a 2025 or 2024 rating was. Comparing this year's score directly against a prior year's score, measure for measure, isn't a like-for-like comparison.
What Is Important About the 2026 Medicare Star Ratings?
CMS published the 2026 ratings in Medicare Plan Finder on October 9, 2025, with a formal fact sheet following on November 18, 2025. Here's what the national numbers actually show.
MA-PD Results
Among rated MA-PD (Medicare Advantage with Part D) contracts:
- 207 contracts (about 40%) earned at least 4 overall stars
- Those contracts cover roughly 64% of MA-PD enrollment
- The enrollment-weighted average overall rating landed at 3.98, up slightly from 3.95 in 2025
That's according to CMS's 2026 Star Ratings fact sheet, and it's specifically about plans bundling medical and drug coverage, not all Medicare Advantage plans broadly.
Stand-Alone Part D Results Look Very Different
Only 9 of 40 rated stand-alone PDP contracts (about 23%) hit 4 or more Part D stars. And here's the gap that matters: just 2% of PDP enrollees were actually in those higher-rated contracts. Most stand-alone drug plan members are enrolled in plans rated between 2.5 and 3.5 stars.
Don't mix these two data sets up. A strong MA-PD average doesn't tell you anything about stand-alone Part D quality, and vice versa.
What This Means Practically
- A lower-rated plan deserves a closer look, not automatic elimination. Check what specifically pulled the score down.
- A high rating doesn't freeze anything in place. Premiums, networks, formularies, and supplemental benefits can all change year to year regardless of star rating.
- 2026 ratings feed 2027 quality bonuses, not 2026 payments, so this year's score shapes what carriers can invest next year.
Star ratings aren't the only 2026 shift worth watching. KFF reported that stand-alone Part D offerings dropped from 464 plans in 2025 to 360 in 2026 nationally. Some carriers pulled back or exited certain states. That's a market trend worth knowing about, not proof that ratings caused any single company's exit.
How to Use 2026 Star Ratings When Comparing Plans
Star ratings are a useful first filter—not the whole decision. Use this sequence to compare the plans that make your shortlist.
Step 1: Pull Up Your Actual Local Options
Enter your ZIP code into Medicare's Plan Finder tool. Record each plan's:
- Overall rating (for MA-PD)
- Part C rating (for MA-only)
- Part D rating (for stand-alone PDPs)
Step 2: Check Provider Access
A 5-star plan is worthless if your doctor isn't in-network. Verify:
- Whether your primary care doctor and specialists participate
- Referral requirements (HMO vs. PPO rules differ significantly here)
- Hospital network coverage
- How far you'd need to travel for in-network care
Step 3: Match Your Prescription List
Pull your complete medication list (names, dosages, and preferred pharmacy) and check it against each plan's formulary. Look specifically at:
- Which drug tier each medication falls under
- Prior authorization or quantity limit requirements
- Mail-order availability
- Estimated annual out-of-pocket drug costs, not just the copay for one prescription
Step 4: Total the Real Cost, Not Just the Premium
A $0 premium plan can still cost more over a full year than a plan with a modest premium. Factor in deductibles, copays, coinsurance, and your maximum out-of-pocket exposure, then build a full-year estimate before you decide.
This is the side-by-side work Wareheim Medicare Advisors does with clients during annual plan reviews. Star ratings get matched against provider networks, drug formularies, and total cost projections for the plans available where you live.
Plan options depend on your location and current CMS-approved offerings, so a personalized check matters more than the star number alone.
What Do Star Ratings Mean for Enrollment and Switching Plans?
Timing rules around Star Ratings trip up a lot of people. Here's what applies for 2026.
| Enrollment window | Timing | What it allows |
|---|---|---|
| Annual Enrollment Period | October 15 – December 7, 2025 | Change MA or Part D coverage, effective January 1, 2026, if received by the deadline |
| Initial Enrollment Period | 3 months before to 3 months after Medicare eligibility | First-time enrollment in MA or Part D |
| 5-Star Special Enrollment Period | December 8, 2025 – November 30, 2026 | One-time switch into an available 5-star MA, Part D, or Medicare Cost plan in your area |
| Consistent poor-performer SEP | Ongoing, triggered by CMS notice | One-time switch out of a contract rated below 3 stars for the last three consecutive years |
The 5-Star Switch Isn't Unlimited
You can use the 5-star SEP only once during the window, and only if a qualifying 5-star plan is actually available where you live. Not every county has one. Check Medicare.gov's official Special Enrollment Period guidance before assuming this option applies to you.
Low-Rated Plan Notifications
If your plan has scored below 3 stars for three consecutive years, CMS mails a notice (typically mid-to-late October) explaining your one-time switching right. A single bad year doesn't trigger this; it takes three years running.
Before You Cancel Anything
- Confirm your new plan actually includes prescription drug coverage if you're leaving a plan that had it
- Switching from an MA plan with drug coverage into a stand-alone 5-star PDP returns you to Original Medicare for medical benefits
- Check your effective date and whether a lapse in coverage could trigger a late-enrollment penalty down the road
Limits of Star Ratings and Common Comparison Mistakes
Star Ratings reflect contract-level performance, not your individual experience. CMS pulls this data from surveys, claims, and prescription-drug-event records, and it often reflects activity from the prior year rather than real-time performance.
A high score is useful context, but it cannot replace a plan-by-plan check of your doctors, drugs, and costs.
Common mistakes to avoid:
- Picking the highest-rated plan without confirming your doctors are in-network
- Skipping the formulary check and assuming "prescription coverage" means your prescriptions are covered
- Comparing plans by premium alone, ignoring deductibles and out-of-pocket maximums
- Relying on last year's rating instead of pulling the current 2026 score
- Assuming a new or unrated plan is automatically low quality. Some simply lack enough data yet
Use the list below to turn those cautions into a quick pre-enrollment review.
Final Checklist Before Enrolling
- Confirm the official 2026 rating in Plan Finder
- Verify your doctors and hospitals are in-network
- Check every prescription against the formulary
- Confirm your preferred pharmacy participates
- Estimate total annual costs, not just the premium
- Review the maximum out-of-pocket limit
- Confirm supplemental benefits you actually need
- Verify your enrollment eligibility and effective date
Frequently Asked Questions
What is considered the best Medicare Advantage plan for 2026?
There's no universal "best" plan. Compare official 2026 ratings against your specific doctors, prescriptions, budget, and coverage priorities to find the best fit for your situation.
What is a 5-star Medicare plan?
A 5-star plan holds CMS's highest possible quality rating for Medicare Advantage or Part D coverage. It still needs to include your providers, cover your medications, and fit your budget to be a good choice.
Can you show me a chart of the CMS star ratings for 2026?
The most reliable source is the official Medicare Plan Finder at Medicare.gov, which displays current 2026 ratings for plans available in your area, along with premiums and benefit details.
How are Medicare Advantage and Part D Star Ratings calculated?
CMS combines quality, member-experience, customer-service, and safety measures into weighted scores. Medicare Advantage and Part D each use a distinct set of measures suited to their type of coverage.
Where can I find the official 2026 Medicare Star Ratings?
Visit Medicare.gov's Plan Finder tool and enter your ZIP code to see current ratings, since availability and ratings vary by location. CMS's published fact sheets also cover national-level results.
Can I switch to a 5-star Medicare Advantage or Part D plan?
A one-time 5-Star Special Enrollment Period runs December 8, 2025 through November 30, 2026, if a qualifying plan is available in your area. Confirm eligibility, drug coverage, and your new effective date before switching.
