Medicare Advantage

What Medicare Star Ratings Really Mean Before Oct. 15

LAWRENCE, Mass. — As the Annual Enrollment Period opens Oct. 15, a familiar set of gold stars will appear next to Medicare Advantage and Part D plans on Medicare.gov. Those Star Ratings are refreshed by the Centers for Medicare & Medicaid Services (CMS) each fall, and they can shape how millions of people compare coverage between now and Dec. 7. But the ratings are often misunderstood — they are a quality snapshot, not a shopping ranking, and knowing what they measure (and what they don't) can help Lawrence-area readers use them more wisely this season.

What Star Ratings actually measure

CMS rates Medicare Advantage and Part D plans on a scale of 1 to 5 stars, with 5 being the highest. The score pulls together dozens of individual measures grouped into broad categories, including:

• Staying healthy — whether members receive recommended screenings, tests, and vaccines.
• Managing chronic conditions — how well plans support members with diabetes, heart disease, and other long-term needs.
• Member experience — survey results on how members rate their plan and their care.
• Member complaints and changes in performance — how often people leave the plan, file complaints, or have problems getting service.
• Customer service — how the plan handles appeals, calls, and requests for information.

Part D drug plans are rated on related measures, such as drug pricing accuracy, medication safety, and member complaints.

Why the fall release matters

CMS publishes updated Star Ratings each October, timed so shoppers can see them during the Annual Enrollment Period, which runs Oct. 15 through Dec. 7. That is the window when most people with Medicare can join, switch, or drop a Medicare Advantage or Part D plan for coverage that starts Jan. 1.

Lawrence is in Essex County, where Medicare Advantage and Part D availability is set at the county level. When you use Medicare.gov's Plan Finder, the star score will appear right alongside each plan available in your ZIP code.

What Star Ratings are not

This is where a lot of confusion creeps in. A high star score does not automatically mean a plan is the right fit for you. Ratings do not tell you:

• Whether your doctors or hospitals are in the plan's network.
• Whether your specific prescriptions are on the plan's formulary.
• What your own out-of-pocket costs would look like.
• How the plan handles a condition unique to your situation.

Two people in the same neighborhood can look at the same 4-star plan and reach very different conclusions once they check networks, drug lists, and travel needs. Star Ratings are one useful input — not the whole decision.

How to use ratings alongside 2027 program changes

The 2027 plan year also brings program-wide updates that apply no matter which plan you pick:

• The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027. Once your covered drug spending hits that limit, you pay nothing for covered Part D drugs the rest of the year.
• The Part D maximum deductible is $615 in 2026 and $700 in 2027.
• The old coverage gap ("donut hole") is gone as of 2025; Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the calendar year in monthly payments instead of paying at the pharmacy counter.
• IRMAA income-related surcharges for Part B and Part D begin above $109,000 for a single filer in 2026.

Reading Star Ratings in that context — knowing the guardrails are the same across plans — can make the comparison feel less overwhelming.

Where to get trustworthy help in Lawrence

You do not have to sort this out alone. Free, unbiased help is available:

• Medicare.gov Plan Finder — enter your ZIP code and drug list to see plans, star scores, and estimated costs.
• 1-800-MEDICARE (1-800-633-4227), open 24/7.
• SHINE (Serving the Health Insurance Needs of Everyone) — the Massachusetts State Health Insurance Assistance Program, which offers free one-on-one counseling to Lawrence residents.