Medicare Advantage

Medicare Star Ratings for 2026: What the Numbers Mean

Mitchell, S.D. — Every fall, just before the Medicare Annual Enrollment Period opens, the Centers for Medicare & Medicaid Services (CMS) publishes updated Star Ratings for Medicare Advantage and Part D plans. The 2026 ratings arrived this October, giving people in Mitchell and across Davison County a fresh yardstick to consider as they review their coverage between Oct. 15 and Dec. 7.

But what do those little star icons actually measure? Here's a plain-English guide.

What Star Ratings are — and what they aren't

Star Ratings are CMS's way of grading how well Medicare Advantage and Part D plans perform. Plans are scored on a scale of 1 to 5 stars, with 5 being the highest.

The rating is a quality signal, not a ranking of "best" or "worst" plans, and not a price tag. Two plans with the same star score can look very different when you compare benefits, networks, and drug lists. Stars tell you how a plan is doing on measurable service and care benchmarks — not whether it fits your particular needs.

What the stars actually measure

For 2026, CMS is scoring plans across roughly 40 individual measures, grouped into a few big buckets:

• Staying healthy — screenings, vaccines, and preventive checkups plan members receive.
• Managing chronic conditions — how well the plan supports people with diabetes, heart disease, and other ongoing needs.
• Member experience — survey feedback on how members rate their plan and care.
• Member complaints and plan performance — including how often people leave the plan or have problems getting service.
• Customer service — call center responsiveness, appeals handling, and timely decisions.
• Drug plan quality (for Part D) — accuracy of pricing, medication safety, and how well the plan helps members take their drugs as prescribed.

Each measure is weighted, and the results roll up into an overall star score.

Why the fall timing matters

CMS releases updated ratings in early October so they are visible in the Medicare Plan Finder at medicare.gov before the Annual Enrollment Period begins on Oct. 15. That's not a coincidence — the goal is to give people useful information while they still have time to make changes for the coming year.

Enrollment for 2026 coverage runs Oct. 15 through Dec. 7, 2025. If you're already in a Medicare Advantage plan, you also get a second window — the Medicare Advantage Open Enrollment Period from Jan. 1 through March 31 — to switch to a different Advantage plan or return to Original Medicare.

The bigger picture for 2026

Star Ratings aren't the only thing changing this fall. A few program-wide facts worth knowing as you review options:

• The Part D out-of-pocket cap is $2,100 for 2026. Once your drug spending hits that number, you pay $0 for covered drugs the rest of the year.
• The Part D deductible maximum is $615.
• The old "donut hole" coverage gap was eliminated in 2025 — Part D now has three phases instead of four.
• The Medicare Prescription Payment Plan lets you spread drug costs across monthly payments instead of paying large amounts at the pharmacy counter.
• IRMAA income surcharges for Part B and Part D begin above $109,000 for a single filer in 2026.

Mitchell is in Davison County, where residents choose from Medicare Advantage and stand-alone Part D options available in that county. Availability is set at the county level, so a neighbor in a different county may see different choices.

How to use Star Ratings sensibly

Think of the star score as one piece of information, not a verdict. When comparing coverage:

1. Start with your doctors and hospitals — are they in the network? 2. Check the plan's drug list against your prescriptions. 3. Look at total expected costs, including premiums and out-of-pocket exposure. 4. Then look at the star score as a signal of the plan's service and care quality track record.

A plan with strong stars but no coverage for your medication isn't the right fit. Neither is a cheap plan that consistently struggles with customer service.