Key Takeaways

• A five-star CMS rating may indicate high performance, but it doesn’t guarantee the best coverage or lowest costs for your personal needs.

• Choosing a Medicare Advantage plan requires looking beyond ratings to compare networks, benefits, out-of-pocket costs, and Medicare integration.

What the CMS Star Ratings Actually Measure

Each year, the Centers for Medicare & Medicaid Services (CMS) releases star ratings for Medicare Advantage (Part C) and Medicare Part D plans. These ratings range from one to five stars and are updated annually, with five stars being the highest possible score.

The CMS star rating is based on more than 40 quality measures, grouped into five categories:

• Staying healthy: Screenings, tests, and vaccinations

• Managing chronic conditions: Monitoring and treatment for ongoing conditions

• Member experience: Satisfaction surveys and feedback

• Customer service: Call center performance, appeals, and timeliness

• Drug safety and accuracy of pricing: For plans that include Part D

While helpful as a general indicator, this rating system may not reflect how well a plan will work for you specifically. It’s a standardized view of quality—not a personal recommendation.

Why Higher Ratings Don’t Always Mean Better for You

A five-star plan might seem like the obvious best choice. But you should look more closely before assuming it fits your needs. Here’s why:

1. Star Ratings Reflect Averages, Not Individual Fit

Star ratings measure how a plan performs on average, across all enrollees. They don’t account for:

• Whether your preferred doctors are in-network

• Whether your prescriptions are on the formulary

• How far you’ll need to travel for care

• How much you’ll pay in deductibles, copayments, or coinsurance

You might find that a four-star plan with your doctors and lower drug costs serves you better than a five-star plan that doesn’t.

2. Some Low-Rated Plans Offer More Generous Benefits

Plans with fewer stars may offer broader supplemental benefits, such as:

• Dental and vision coverage

• Hearing aids

• Transportation to medical appointments

• Over-the-counter allowances

In some regions, plans with three or four stars include benefits not available in higher-rated options. Again, your personal needs determine the real value.

3. Star Ratings Can Change Every Year

The CMS updates star ratings annually based on current performance. A plan with five stars this year may drop to four next year, and vice versa. Relying solely on a rating without reviewing other details may lead to surprises in the next coverage year.

Key Features to Compare in Medicare Advantage Plans

To choose the best plan for your situation in 2025, you need to look at a broader set of criteria than just the star rating.

Provider Networks

Each Medicare Advantage plan contracts with a specific network of doctors, hospitals, and specialists. Confirm that:

• Your primary care provider is in-network

• Your preferred specialists and facilities are covered

• You understand the plan’s rules for referrals or out-of-network care

Out-of-network costs can be significantly higher or not covered at all, depending on the plan type (HMO, PPO, etc.).

Prescription Drug Coverage

Most Medicare Advantage plans include Part D drug coverage, but formularies differ. Review:

• Whether your medications are covered

• Which tier your drugs fall under

• Pharmacy network access

Using non-preferred pharmacies or drugs in higher tiers can significantly increase your costs.

Out-of-Pocket Costs

Even plans with no monthly premium may include other costs. Be sure to check:

• Annual deductible (if any)

• Copayments for office visits, hospital stays, and urgent care

• Coinsurance for durable medical equipment, lab tests, or specialty drugs

• Maximum out-of-pocket limit (in 2025, CMS caps in-network MOOP at $9,350)

These costs can add up, especially if you need regular care.

Supplemental Benefits

In 2025, most plans still offer extras, but the scope varies. These may include:

• Routine dental cleanings and x-rays

• Eye exams and eyeglasses

• Hearing tests and aids

• Fitness memberships

• Meals after hospitalization

Don’t assume all plans cover these, or cover them equally. Check the specifics.

Medicare Coordination

If you’re eligible for both Medicare Advantage and Medicare Part B, see how the plan coordinates:

• Some plans may waive or reduce deductibles if you have Part B

• Others may offer partial reimbursement for Part B premiums

• Integrated drug plans may lower your out-of-pocket prescription costs

Plans designed to work with Medicare often provide better financial protection, especially if you manage chronic conditions.

The Importance of Regional Availability

Plan quality and availability vary by zip code. A five-star plan in one county may not be offered in another. In 2025, CMS reports slight regional shifts in star performance and availability of Special Needs Plans (SNPs).

When comparing options, be sure you are looking at plans available in your specific service area. You may have:

• 5 to 20 different plans available, depending on location

• Several plan types, such as HMOs, PPOs, PFFS, or SNPs

• Variations in supplemental benefits and provider networks

Always filter your comparison tools by your zip code to avoid reviewing plans that don’t apply to you.

What a Five-Star Rating Does Do for You

Though not a guarantee of personal satisfaction, a five-star CMS rating does offer real advantages:

• Special Enrollment Period (SEP): If a five-star plan is available in your area, you can switch to it at any time once per year, outside of standard enrollment windows.

• Administrative quality: These plans tend to process claims and appeals more efficiently

• Preventive care focus: High-rated plans often excel in screenings, follow-ups, and vaccination programs

Just remember that even a five-star plan should be checked against your own needs before enrolling.

Timelines and Deadlines You Should Know

Understanding when you can enroll or switch plans is just as critical as knowing what to choose. In 2025, these are the main Medicare Advantage enrollment periods:

Initial Enrollment Period (IEP)

• When: Begins three months before you turn 65 and ends three months after

• What you can do: Enroll in Medicare Parts A and B, and a Medicare Advantage plan

Annual Enrollment Period (AEP)

• When: October 15 to December 7 each year

• What you can do: Change, drop, or enroll in a Medicare Advantage plan for the next calendar year

Medicare Advantage Open Enrollment Period (MA OEP)

• When: January 1 to March 31

• What you can do: If already enrolled in Medicare Advantage, switch to another plan or return to Original Medicare

Five-Star Special Enrollment Period

• When: Once per calendar year, anytime

• What you can do: Switch to a five-star rated plan if one is available in your service area

Missing these windows can mean waiting months to change your plan unless you qualify for a Special Enrollment Period triggered by a qualifying event (such as moving or losing coverage).

How to Evaluate the Best Plan for You

Use a structured approach when comparing plans. Consider the following checklist:

• Star rating: Consider quality, but don’t treat it as a dealbreaker

• Monthly premium: Look at total cost, not just monthly payments

• MOOP (Maximum Out-of-Pocket): Compare caps on expenses

• Doctor access: Confirm your providers are in-network

• Prescription coverage: Match the plan’s formulary with your needs

• Supplemental benefits: Evaluate value-added services

• Part B coordination: Understand how the plan complements Medicare

Using this process ensures you don’t overvalue a star rating while ignoring the fine print that impacts your care and wallet.

Make a Fully Informed Decision in 2025

The best Medicare Advantage plan for you in 2025 might have five stars—or it might not. It depends on your personal situation, health status, financial preferences, and geographic location. While star ratings are helpful, they should be one piece of a broader evaluation process.

If you’re unsure how to balance all these moving parts, speak with a licensed agent listed on this website. They can help you compare plans side-by-side based on your real-world needs, not just CMS scores.