Medicare Advantage

Before You Shop in Monmouth County: Star Ratings 101

MIDDLETOWN, N.J. — Every fall, just before Medicare's Annual Enrollment Period opens on October 15, the federal government publishes fresh Star Ratings for Medicare Advantage and Part D plans. The 2027 ratings will land on Medicare.gov this October, and for Middletown residents weighing coverage choices for 2027, it helps to know what those one-to-five stars are actually grading — and, just as importantly, what they are not.

Medicare AdvantageMiddletown, NJ

What Star Ratings actually are

CMS grades Medicare Advantage and stand-alone Part D drug plans on a scale of one to five stars, with five being the highest. The rating is meant to give shoppers a quick, standardized read on how a plan has been performing — similar in spirit to a restaurant health score, but broader.

The scores are published once a year, in October, and apply to the plan year that follows. So the ratings released this fall will describe how plans performed based on the most recent data CMS has collected, and they'll be attached to plans as people shop for 2027 coverage.

What the stars measure

For Medicare Advantage plans that include drug coverage, CMS looks at roughly 40 individual measures grouped into big categories:

• Staying healthy: whether members get recommended screenings, tests, and vaccines.
• Managing chronic conditions: how well the plan supports people living with diabetes, heart disease, and similar conditions.
• Member experience: what enrollees say in surveys about their care and the plan.
• Member complaints and changes in performance: how often people leave, complain, or have problems.
• Customer service: how the plan handles calls, appeals, and new-member requests.
• Drug safety and pricing accuracy (for plans with Part D): things like accurate pricing on Medicare.gov and safe prescribing patterns.

Stand-alone Part D plans are scored on a shorter list focused on drug-related measures.

What Star Ratings do not measure

This is where a lot of shoppers get tripped up. Star Ratings don't tell you:

• Whether your doctor or hospital is in the plan's network.
• Whether your specific prescriptions are covered, or what tier they land on.
• What the plan costs you personally — premiums, copays, and deductibles are separate.
• Whether extras like dental, vision, or hearing benefits fit your needs.

In other words, two plans with the same star count can look very different once you plug in your own doctors and medications.

How to see them for your area

Middletown is in Monmouth County, where Medicare plan availability is set at the county level. To see the ratings for plans offered locally:

1. Go to Medicare.gov and open the Plan Finder. 2. Enter your ZIP code and, if you want, your prescriptions. 3. Each plan card will show a star rating alongside its cost and coverage details.

You can also call 1-800-MEDICARE (TTY 1-877-486-2048), available 24/7, or reach out to New Jersey SHIP (State Health Insurance Assistance Program) for free, unbiased one-on-one counseling.

Why this matters this fall

The 2027 plan year brings several program-wide changes worth knowing about as you compare options during AEP (October 15 – December 7):

• The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027.
• The Part D maximum deductible is $615 in 2026 and $700 in 2027.
• The coverage gap (the old "donut hole") is gone 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 — it's optional and free to join.
• IRMAA surcharges on Part B and Part D begin above $109,000 in income for a single filer in 2026.

Star Ratings sit alongside those facts as one more piece of the picture — useful context, not a scoreboard.