Navigating the world of Medicare can be complex, especially when it comes to choosing the right coverage. For seniors and individuals with disabilities, access to high-quality, stable, and affordable Medicare options is crucial. The Centers for Medicare & Medicaid Services (CMS) plays a vital role in ensuring this access by evaluating and rating Medicare Advantage (MA) and Part D prescription drug plans. These ratings, known as Star Ratings, are designed to help you compare medicare plans effectively and make informed decisions about your healthcare.
Each year, CMS releases updated Star Ratings, offering a transparent measure of plan quality. The 2025 Star Ratings are now available and will be a key factor for Medicare beneficiaries as they consider their options during the upcoming open enrollment period for 2025 coverage, impacting quality bonus payments for plans in 2026. Understanding these ratings is essential to compare medicare plans and select one that best meets your individual health needs.
This article breaks down the key findings of the 2025 Star Ratings, highlighting what they mean for you when you compare medicare plans. We’ll explore how these ratings are calculated, what changes have been implemented for 2025, and how you can use this information to choose a high-quality Medicare plan.
Key Highlights of 2025 Medicare Advantage and Part D Star Ratings
The Medicare Star Ratings system assesses Medicare Advantage Prescription Drug (MA-PD) contracts, MA-only contracts, and standalone Prescription Drug Plans (PDPs) based on numerous quality and performance measures. MA-PD plans are evaluated on up to 40 measures, MA-only plans on up to 30, and PDPs on up to 12. These measures cover a wide range of factors, from preventive care and chronic condition management to customer service and member experience.
For each measure, CMS sets performance thresholds, or “cut points,” to assign star ratings from 1 to 5 stars. A 5-star rating represents exceptional performance, while a 1-star rating indicates poor performance. These ratings are crucial when you compare medicare plans, providing a quick snapshot of plan quality.
Minor Methodological Adjustments for 2025 Star Ratings
While there were no significant changes to the core methodology for the 2025 Star Ratings, CMS implemented minor adjustments to refine the system. One notable change is the increased weight for the “Part C Plan All-Cause Readmissions” measure, which has been raised from a weight of one to three. This emphasizes the importance of plans effectively managing readmissions and ensuring continuity of care for their members.
Another adjustment concerns the “Part D Medicare Plan Finder” measure. Previously considered a new measure, it now has bi-directional guardrails applied after mean resampling if cut points change by more than 5%. However, these guardrails were not triggered for the 2025 Star Ratings as cut point shifts were within the 5% threshold.
These subtle methodological refinements reflect CMS’s ongoing commitment to improving the accuracy and stability of the Star Ratings system, ensuring that when you compare medicare plans using these ratings, you are benefiting from the most reliable quality assessments possible.
Impact of Past Rule Changes on 2025 Ratings
It’s important to note that changes implemented in previous years continue to shape the current Star Ratings landscape. For the 2024 Star Ratings, CMS introduced Tukey outlier deletion to the hierarchical clustering methodology used to set cut points for non-Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures. This change, established through prior rulemaking (85 FR 33796), aims to improve the accuracy of measure-level cut points by minimizing the influence of extreme outliers, particularly those at the lower end of performance.
Table 1: Trend of Overall Star Rating Distribution for Medicare Advantage Prescription Drug (MA-PD) Contracts from 2022 to 2025, showing changes in contract numbers and enrollment percentages across different star rating categories.
The application of Tukey outlier deletion can lead to an upward shift in cut points because the removal of low-performing outliers raises the average performance level. While guardrails can sometimes limit the full impact of this deletion on cut point adjustments, the overall effect is a more precise and robust rating system. This means that when you compare medicare plans based on 2025 ratings, you are seeing the results of a refined evaluation process designed to highlight truly high-performing plans.
2025 Star Rating Distribution: What the Numbers Tell You
Analyzing the distribution of Star Ratings provides valuable insights into the overall quality landscape of Medicare Advantage and Part D plans.
- Medicare Advantage Prescription Drug (MA-PD) Plans:
- Approximately 40% of MA-PD contracts (209 contracts) for 2025 achieved a rating of four stars or higher.
- Impressively, about 62% of MA-PD enrollees are in plans that will receive four or more stars in 2025, weighted by enrollment.
These figures suggest that a significant portion of Medicare Advantage plans offer high-quality care and services. However, it’s important to note that the average overall Star Rating for MA-PDs has slightly decreased from 4.37 in 2022 to 3.92 in 2025. This shift underscores the dynamic nature of the Star Ratings, reflecting both changes in plan performance and adjustments to the rating methodology.
- Standalone Prescription Drug Plans (PDPs):
- Around 27% of PDPs (11 contracts) active in 2025 earned four or more stars for their 2025 Part D rating.
- However, only about 5% of PDP enrollees are in contracts with four or more stars, weighted by enrollment.
The distribution for PDPs indicates a more concentrated range of ratings compared to MA-PDs. The average Part D rating for PDPs has also seen a decrease, from 3.70 in 2022 to 3.06 in 2025. These trends are essential to consider when you compare medicare plans, particularly if you are focused on prescription drug coverage.
Table 2: Distribution of Part D Star Ratings for standalone Prescription Drug Plans (PDPs) across the years 2022-2025, showing the number of contracts and enrollment percentages for each rating level.
Factors Influencing Changes in Star Ratings
Year-over-year variations in Star Ratings are expected and reflect the dynamic nature of healthcare and the continuous improvement goals of CMS. Several factors contribute to these changes:
- Outlier Removal: As mentioned earlier, the Tukey outlier deletion method removes extreme outliers, primarily from the lower end of performance. This leads to upward shifts in cut points, requiring plans to achieve higher performance levels to maintain high ratings.
- Return to Pre-Pandemic Performance: Performance on some measures is returning to pre-pandemic levels, which can also result in increased cut points as overall performance benchmarks rise.
- Compressed Score Distribution: A more compressed distribution of scores across plans can lead to increases in cut points, as the range of performance narrows and higher standards are set.
- High-Performing Contracts: The increasing number of contracts achieving very high scores on certain measures, like Breast Cancer Screening, pushes cut points higher for those measures, raising the bar for top ratings.
- Improved Low-End Performance: Even improvements in scores among lower-performing contracts on measures like Colorectal Cancer Screening can contribute to higher cut points, reflecting an overall elevation of quality standards.
These factors collectively contribute to a more rigorous and discerning Star Ratings system, ensuring that when you compare medicare plans, the ratings reflect a constantly evolving landscape of quality and performance.
5-Star Medicare Plans: Identifying Top Performers
For 2025, a select group of Medicare plans have achieved the highest distinction of 5-star ratings, signifying exceptional performance across quality measures. A total of 11 contracts are recognized with a high-performing icon on the Medicare Plan Finder:
- Seven MA-PD contracts
- Two 1876 Cost Contracts
- Two PDPs
Notably, 10 of these contracts also received the high-performing icon in 2024, demonstrating consistent excellence. Six of the seven 5-star MA-PD contracts include Dual Eligible Special Needs Plans (D-SNP), highlighting high-quality options for beneficiaries with dual eligibility for Medicare and Medicaid.
When you compare medicare plans, 5-star rated plans represent the pinnacle of quality and service. Choosing a 5-star plan can offer peace of mind, knowing you are selecting a plan recognized for its superior performance in delivering healthcare and member satisfaction.
Consistently Low Performers: Plans to Consider with Caution
In contrast to the high-performing plans, CMS also identifies contracts with consistently low quality ratings. For 2025, eight contracts are designated with a low-performing icon on the Medicare Plan Finder. These include:
- Seven MA-PD contracts
- One PDP
Six contracts received this designation last year, indicating a slight increase in the number of consistently low-performing plans. Two of the low-performing MA-PD contracts include D-SNP plan benefit packages.
While beneficiaries have the freedom to choose any Medicare plan, it is prudent to carefully consider the performance history of plans designated as low-performing. When you compare medicare plans, this information can help you avoid plans that have struggled to meet quality standards.
Tax Status, Program Tenure, and Star Ratings: Trends to Note
The 2025 Star Ratings data also reveals interesting correlations between plan performance and factors like tax status and length of time in the Medicare program.
- Tax Status: Non-profit organizations tend to achieve higher Star Ratings more frequently than for-profit organizations.
- Approximately 50% of non-profit MA-PD contracts received four or more stars, compared to 36% of for-profit MA-PDs.
- Similarly, about 41% of non-profit PDPs achieved four or more stars, versus 17% of for-profit PDPs.
These trends suggest that organizational structure and mission may influence plan performance. When you compare medicare plans, you might consider whether a plan’s tax status aligns with your priorities for healthcare quality and member focus.
Table 3: Comparison of 2025 Overall Star Ratings distribution for For-profit and Non-profit Medicare Advantage Prescription Drug (MA-PD) contracts, showing contract numbers and enrollment weighting.
- Program Tenure: More experienced MA-PD contracts generally achieve higher overall Star Ratings.
- MA-PDs with 10 or more years in the program are more likely to have four or more stars compared to newer contracts (less than five years).
- The relationship is less clear for PDPs due to the limited number of newer PDP contracts.
Experience in the Medicare program appears to be a factor in achieving and maintaining high quality ratings. When you compare medicare plans, you may want to consider the longevity and track record of a plan within the Medicare system.
Table 4: 2025 Part D Star Ratings distribution across For-profit and Non-profit Prescription Drug Plans (PDPs), detailing contract numbers and enrollment weighting by tax status.
Average Star Ratings by Measure: Deep Dive into Performance Areas
Beyond overall Star Ratings, examining average star ratings for individual measures provides a deeper understanding of plan performance across specific areas of care and service.
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Part C Measures: Table 7 details the average star ratings for Part C measures from 2022 to 2025. Notable trends include:
- Decreases in average ratings for preventive care measures like Breast Cancer Screening and Colorectal Cancer Screening.
- Relatively stable or slightly improving average ratings for measures related to care coordination, customer service, and plan administration.
- Fluctuations in average ratings for chronic condition management measures like Diabetes Care and Controlling Blood Pressure.
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Part D Measures (MA-PDs and PDPs): Tables 8 and 9 present average star ratings for Part D measures for MA-PDs and PDPs, respectively. Key observations include:
- Consistent average ratings for measures related to complaints and member retention.
- Variability in average ratings for medication adherence measures, with some showing slight declines.
- Fluctuations in average ratings for measures related to drug plan quality improvement and getting needed prescription drugs.
Table 5: 2025 Overall Star Ratings distribution for Medicare Advantage Prescription Drug (MA-PD) contracts, categorized by the length of time the contracts have been in the program.
Analyzing these measure-level average ratings can help you compare medicare plans based on the specific aspects of care and service that are most important to you. For example, if medication management is a priority, you might focus on plans with higher average ratings for medication adherence measures.
Table 6: Distribution of 2025 Part D Star Ratings for Prescription Drug Plans (PDPs), categorized by contract duration in the Medicare program.
Using Star Ratings to Compare Medicare Plans Effectively
The Medicare Star Ratings are a powerful tool for consumers to compare medicare plans and make informed healthcare decisions. Here’s how you can effectively use these ratings:
- Start with the Medicare Plan Finder: The Medicare Plan Finder on Medicare.gov is your primary resource for accessing Star Ratings. You can search for plans in your area and easily see their overall and measure-level ratings.
- Focus on Overall Star Ratings: The overall Star Rating provides a quick summary of a plan’s quality. When you initially compare medicare plans, prioritize those with 4 stars or higher for a higher likelihood of quality care and service.
- Drill Down to Measure-Level Ratings: For a more detailed comparison, explore the measure-level ratings. Identify the measures that are most relevant to your health needs and preferences. For example, if you have diabetes, pay close attention to the Diabetes Care measures.
- Consider 5-Star Plans: If available in your area, explore 5-star rated plans as they represent the highest level of quality. These plans may offer enhanced benefits and a superior member experience.
- Be Aware of Low-Performing Plans: Take note of plans with low-performing icons and investigate further. While these plans may still be an option, understand the reasons for their low ratings and consider if those factors are significant to your healthcare needs.
- Look Beyond Star Ratings: While Star Ratings are valuable, also consider other factors when you compare medicare plans, such as:
- Plan Benefits and Costs: Compare premiums, deductibles, copays, and covered services.
- Provider Network: Ensure your preferred doctors and hospitals are in the plan’s network.
- Prescription Drug Coverage (for Part D): Check if your medications are covered and compare drug costs.
- Customer Service and Support: Assess plan resources and member support services.
Conclusion: Empowering Your Medicare Choices with Star Ratings
The 2025 Medicare Star Ratings provide valuable insights into the quality and performance of Medicare Advantage and Part D plans. By understanding how these ratings are calculated, interpreting the distribution data, and considering the trends and factors influencing ratings, you can effectively compare medicare plans and make informed decisions about your healthcare coverage.
CMS’s ongoing efforts to refine and enhance the Star Ratings system demonstrate a commitment to transparency and quality improvement within the Medicare program. Utilizing these ratings, along with considering your individual health needs and preferences, empowers you to choose a Medicare plan that offers the best possible care, coverage, and peace of mind. As you prepare for the upcoming enrollment period, leverage the power of Medicare Star Ratings to navigate your options and select a plan that truly meets your needs.
References:
- Announcement of Calendar Year (CY) 2025 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies: https://www.cms.gov/files/document/2025-announcement.pdf
- Medicare Program, Contract Year 2021 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program Final Rule (85 FR 33796): https://www.federalregister.gov/documents/2020/06/02/2020-11342/medicare-program-contract-year-2021-policy-and-technical-changes-to-the-medicare-advantage-program
Note: The tables and images used in this article are sourced from the original CMS document to maintain accuracy and proper attribution.
Table 7: Average Star Ratings for Part C measures across the years 2022-2025, detailing performance trends in various healthcare service areas.
Table 8: Trend of Average Star Ratings for Part D measures within Medicare Advantage Prescription Drug (MA-PD) plans from 2022 to 2025.
Table 9: Average Star Rating changes for Part D measures in standalone Prescription Drug Plans (PDPs) between 2022 and 2025.
