Medicare Advantage

How Medicare Star Ratings Work Before Dec. 7

WHITEFISH, Mont. — With Medicare's Annual Enrollment Period running October 15 through December 7, many people here in Flathead County will see "Star Ratings" pop up as they compare coverage on Medicare.gov. Those little star icons can be helpful — but only if you know what they actually measure, and what they don't.

Here's a plain-language guide to Medicare Star Ratings, refreshed each fall by the Centers for Medicare & Medicaid Services (CMS), and how to use them without getting steered off course.

What Star Ratings actually are

Star Ratings are a quality measurement system run by CMS. Every year, CMS scores Medicare Advantage plans (Part C) and stand-alone Medicare drug plans (Part D) on a scale of 1 to 5 stars, with 5 being the highest.

The ratings are not a ranking of "best" plans. They are a snapshot of how a plan performed on dozens of specific measures — things like customer service, member complaints, how members rate their care, and how well the plan helps people manage chronic conditions.

When new ratings come out

CMS publishes updated Star Ratings each fall, typically in early to mid-October. That timing is on purpose: the ratings are meant to be available before the Annual Enrollment Period begins on October 15, so people can factor quality into their decisions during AEP, which ends December 7.

You can view the current ratings on the official plan finder at medicare.gov. They appear next to each plan when you compare options.

What the stars measure

For Medicare Advantage plans that include drug coverage, CMS looks at roughly 40 different measures. For drug-only plans, it's about a dozen. Broadly, these fall into a few buckets:

• Staying healthy: whether members get recommended screenings, tests, and vaccines.
• Managing chronic conditions: how the plan supports members with diabetes, heart disease, and similar issues.
• Member experience: survey results about the plan and the care people receive.
• Member complaints and plan performance: how often members leave the plan, complaints filed, and appeals.
• Customer service: how the plan handles calls, questions, and appeals in a timely way.
• Drug safety and pricing accuracy: for plans with drug coverage, including how well the plan supports safe medication use.

What the stars do not tell you

This is where a lot of people get tripped up. Star Ratings do not tell you:

• Whether your doctor or hospital in the Flathead Valley is in a plan's network.
• Whether your specific prescriptions are covered.
• What a plan will cost you personally.
• Whether a plan is a good fit for your health situation.

A higher-rated plan isn't automatically the right plan for you, and a lower-rated plan isn't automatically wrong. Ratings are one input among several.

How to use ratings without making a common mistake

The most common mistake is using stars as a shortcut and skipping the real homework. To avoid that:

1. Check that your doctors and preferred hospitals accept the plan. 2. Confirm your medications are on the plan's drug list (formulary). 3. Look at the full cost picture — premiums, deductibles, copays, and the Part D out-of-pocket cap, which is $2,100 in 2026. The Part D maximum deductible is $615, and the old "donut hole" coverage gap was eliminated in 2025, leaving three cleaner payment phases. 4. If drug costs hit hard early in the year, ask about the Medicare Prescription Payment Plan, which lets you spread drug costs across monthly payments. 5. Then look at the Star Rating as a quality signal — not a verdict.

Whitefish is in Flathead County, where residents typically have a broad set of Medicare Advantage and Part D plans to compare each fall. That's a good thing, but it also means the details matter.

A quick note on income and IRMAA

If your income is above $109,000 (single filer, 2026) or $218,000 (joint), you may pay an income-related monthly adjustment amount, or IRMAA, on top of your Part B and Part D premiums. This isn't tied to Star Ratings, but it's worth knowing before enrollment season so nothing surprises you.