Medicare Advantage

Before Oct. 15: What Medicare's Star Ratings Actually Grade

EDISON, N.J. — With the Medicare Annual Enrollment Period opening October 15, federal quality scores known as Star Ratings are back in the spotlight for residents comparing coverage this fall. The ratings, published each October by the Centers for Medicare & Medicaid Services (CMS), are one of the few standardized tools that let shoppers see how Medicare Advantage and Part D plans performed on things like customer service, care quality, and handling of member complaints.

Edison is in Middlesex County, where beneficiaries will see updated Star Ratings alongside plan details on Medicare.gov when the Plan Finder refreshes for the 2027 plan year. Here's what those stars actually measure — and, just as importantly, what they don't.

What Star Ratings actually measure

Star Ratings are CMS's yearly report card for Medicare Advantage (Part C) and Medicare Part D drug plans. Plans are scored from 1 star (poor) to 5 stars (excellent), in half-star steps.

For Medicare Advantage plans that include drug coverage, CMS looks at roughly 40 different measures. For stand-alone Part D plans, it's a smaller set focused on drug-related quality. The measures fall into broad categories such as:

• Staying healthy — screenings, tests, and vaccines members received.
• Managing chronic conditions — how well plans support members with diabetes, heart disease, and similar needs.
• Member experience — satisfaction surveys about the plan and its care.
• Member complaints and changes in performance — how often people leave the plan, and whether service is improving.
• Customer service — call center performance, appeals handling, and access to needed care.
• Drug safety and pricing accuracy — for plans with drug coverage.

Notice what's missing from that list: premiums, copays, and provider networks. Star Ratings don't grade a plan on cost or on whether your particular doctor is in-network.

How and when the ratings are published

CMS releases the new Star Ratings each October, typically a week or two before the Annual Enrollment Period begins on October 15. The ratings appear on the official Plan Finder at Medicare.gov and in each plan's marketing materials.

Ratings are based on data from earlier years — surveys, clinical records, and complaint logs — so a plan's 2027 rating reflects how it performed in prior measurement periods, not real-time service today.

Why the timing matters this fall

The 2027 plan year brings several notable Medicare changes worth knowing before you shop:

• The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027.
• The Part D maximum deductible is $615.
• The old coverage gap, or "donut hole," has been eliminated as of 2025; Part D now has three phases.
• The Medicare Prescription Payment Plan lets enrollees spread drug costs across the year in monthly installments if they choose.
• IRMAA income surcharges for higher earners begin above $109,000 for a single filer in 2026.

With these structural changes, many people are re-shopping coverage this fall. Star Ratings can help narrow that comparison, but they work best alongside a check of your prescriptions, providers, and total expected costs.

How to use — and not overuse — the stars

A higher Star Rating generally signals a plan has done well on the measures CMS tracks. But two plans with the same rating can still work very differently for you. A 4-star plan with a strong local network may serve one Edison resident well, while a neighbor with different medications and doctors may find a different plan fits better.

Use Star Ratings the way you'd use restaurant reviews: helpful context, not the whole story. Always confirm:

• Your prescriptions are on the plan's drug list (formulary).
• Your doctors and preferred hospitals participate.
• The total picture of premium, deductible, and cost-sharing matches your budget.

Where to get unbiased help

Middlesex County residents can compare plans and view current Star Ratings at Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227), which is staffed 24/7. New Jersey's State Health Insurance Assistance Program (SHIP) offers free, one-on-one counseling from trained volunteers who don't sell insurance. Local SHIP counselors often work through county offices on aging and senior centers.

Key dates to keep on the fridge:

• October 15 – December 7: Annual Enrollment Period for Medicare Advantage and Part D changes.
• January 1 – March 31: Medicare Advantage Open Enrollment Period, for people already in a Medicare Advantage plan who want to switch or return to Original Medicare.