Medicare Advantage

What Medicare Star Ratings Actually Measure Each Fall

PITTSFIELD, Mass. — As fall approaches and Medicare's Annual Enrollment Period (Oct. 15 – Dec. 7) draws near, Pittsfield residents are starting to see mailers, TV ads, and websites mentioning "Star Ratings." Every October, the Centers for Medicare & Medicaid Services (CMS) publishes updated ratings for Medicare Advantage and Part D drug plans. Understanding what those little stars actually measure — and what they don't — can help you make sense of what lands in your mailbox this season.

What Star Ratings actually measure

Medicare Star Ratings give each Medicare Advantage and Part D plan a score from 1 to 5 stars, with 5 being the highest. CMS looks at dozens of quality measures, grouped into a few broad categories:

• Staying healthy: whether members get recommended screenings, vaccines, and check-ups.
• Managing chronic conditions: how well the plan supports people with diabetes, heart conditions, and similar needs.
• Member experience: survey results on satisfaction with the plan and its doctors.
• Member complaints and plan performance: how often members leave, file complaints, or have problems getting care.
• Customer service: how the plan handles appeals, calls, and requests for information.

Part D drug plans are rated on similar categories, including drug pricing accuracy and how well the plan helps members take medications safely.

When and where the ratings are published

CMS releases the new Star Ratings each October on medicare.gov, timed so they're available before the Annual Enrollment Period opens on Oct. 15. When you use the Plan Finder tool at medicare.gov, the star score appears next to each plan's name. Ratings are refreshed once a year, so the numbers you see this fall reflect the most recent measurement cycle.

What Star Ratings do not tell you

This is where a lot of Pittsfield readers get tripped up. A high star score is a signal of overall plan quality, but it does not tell you:

• Whether your specific doctor or hospital is in the plan's network.
• Whether your prescriptions are covered on the plan's drug list.
• What your personal out-of-pocket costs will be.
• Whether the extras a plan advertises are useful for your health situation.

In other words, a plan can have strong ratings and still not be the right fit for your circumstances — and a plan with fewer stars might cover the doctors and drugs you already use. The ratings are a starting point, not a final answer.

Local context for Berkshire County

Pittsfield is in Berkshire County, and Medicare Advantage and Part D plan availability is set at the county level. That means the menu of plans a neighbor in Lenox or Great Barrington sees is the same one you see in Pittsfield. When you check the Plan Finder or talk with a counselor, the county — not the city — is what determines your choices.

A few 2026 & 2027 program facts worth knowing

While you're reviewing Star Ratings, it helps to have the year's program-level numbers in mind:

• The Part D out-of-pocket cap is $2,100 for 2026.
• The maximum Part D deductible is $615.
• The old coverage gap (the "donut hole") has been eliminated as of 2025; Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread drug costs across the year in monthly installments if that helps your budget.
• IRMAA income-based surcharges begin above $109,000 for a single filer in 2026.
• Annual Enrollment Period: Oct. 15 – Dec. 7. Medicare Advantage Open Enrollment: Jan. 1 – March 31.

Where to get unbiased help in Pittsfield

For personalized answers, use these free, official resources:

• Medicare.gov — the Plan Finder tool shows Star Ratings side by side with plan details.
• 1-800-MEDICARE (1-800-633-4227) — available 24/7.
• Massachusetts SHINE program (the state's SHIP): trained counselors offer free, one-on-one Medicare help, including in the Berkshires. Call 1-800-243-4636 to be connected to a local counselor.