A Guide to the Highest-Rated Medicare Advantage Plans

Searching for a Medicare Advantage plan can feel overwhelming, but you’re asking the right question: which plans have the highest ratings? Understanding these ratings is the best way to find a quality plan that fits your needs. This guide breaks down the official rating system, highlights top-rated plans, and shows you how to find the best options in your area.

Understanding the Medicare Star Rating System

The single most important tool for judging the quality of a Medicare Advantage (Part C) or Part D prescription drug plan is the official Star Rating System from the Centers for Medicare & Medicaid Services (CMS). Each year, CMS evaluates plans on a scale of 1 to 5 stars, with 5 stars being the highest possible rating.

This system was created to give you a clear, unbiased way to compare plans based on quality and performance. A plan with a 5-star rating is considered excellent, while a plan with 1 or 2 stars has poor performance. These ratings are not just arbitrary numbers; they are based on dozens of specific performance metrics.

What Do the Stars Actually Measure?

The Star Ratings are calculated from several key categories that reflect the complete member experience. A plan must perform well across all these areas to achieve a high rating.

• Staying Healthy: This measures how well the plan helps members stay healthy with preventive services. It includes screenings like mammograms and colonoscopies, as well as member access to flu shots and other vaccines.
• Managing Chronic Conditions: This category is crucial for members with long-term health issues like diabetes, high blood pressure, or arthritis. CMS looks at how well the plan helps members manage their conditions, such as providing access to necessary tests and medications.
• Member Experience: This reflects how current members feel about the plan. It’s based on surveys that ask about their satisfaction with the health plan, the ease of getting appointments, and their ability to get the care they need.
• Customer Service: This category tracks the plan’s operational efficiency and responsiveness. It includes how the plan handles member appeals, enrollment and disenrollment requests, and the accuracy of its call center.
• Drug Plan Services: For Medicare Advantage plans that include prescription drug coverage (MA-PDs), this section is vital. It measures patient safety, the accuracy of drug pricing information, and member satisfaction with the drug plan.

A plan that scores high in these areas is one that is actively working to keep its members healthy, provides excellent service, and manages care effectively.

Which Companies Offer the Highest-Rated Plans?

The question “Which plan has the highest rating?” doesn’t have a single, nationwide answer. A 5-star plan from one company might only be available in a few specific counties. The best plan for you is always a local decision.

However, we can look at the companies that consistently offer 5-star plans across various regions. For 2024, CMS awarded a 5-star rating to several dozen plans across the country. While many are smaller, regional plans, some larger, well-known insurance carriers also offer highly-rated options in certain markets.

Here are some examples of insurance providers that offered plans with a 5-star overall rating for 2024 in at least one location:

• KelseyCare Advantage: This provider, primarily based in the Houston, Texas area, is frequently recognized for its high-quality, integrated care model and consistently earns 5-star ratings.
• UPMC for Life: Serving members in Pennsylvania and other nearby states, UPMC for Life is another carrier that regularly achieves 5-star ratings for its HMO and PPO plans.
• UnitedHealthcare: As one of the largest Medicare Advantage providers in the country, UnitedHealthcare offers several 5-star plans in various states. Their highly-rated plans are often tied to specific medical networks.
• Humana: Another major national carrier, Humana, has multiple plans that achieved a 5-star rating in different regions for 2024.
• Kaiser Permanente: Known for its integrated healthcare system, Kaiser Permanente consistently receives high ratings in the states it serves, including California, Colorado, and the Mid-Atlantic states.

Important Note: The availability of these specific 5-star plans is entirely dependent on your zip code. A 5-star plan from UnitedHealthcare in Florida is a different plan than one offered in Arizona. You must check for plans available specifically where you live.

How to Find 5-Star Plans in Your Area

The best and most reliable way to find the highest-rated plans available to you is by using the official Medicare Plan Finder tool on the Medicare.gov website.

1. Go to Medicare.gov: Navigate to the official government website.
2. Use the Plan Finder Tool: You will be prompted to enter your zip code.
3. Enter Your Information (Optional but Recommended): For the most accurate results, you can enter your prescription drugs and preferred pharmacies. This allows the tool to give you a precise cost estimate for each plan.
4. Filter and Sort by Star Rating: Once you see the list of available plans, you can sort the results by the “Overall Star Rating.” This will bring all the 4.5 and 5-star plans to the top of your list, making it easy to compare the best options.

Using this tool ensures you are looking at the most current, official ratings and seeing only the plans you are actually eligible to enroll in.

The Special Advantage of a 5-Star Plan

Choosing a 5-star plan comes with a unique benefit: the 5-Star Special Enrollment Period (SEP).

Normally, you can only switch Medicare Advantage plans during the Annual Enrollment Period (from October 15 to December 7). However, if a 5-star plan is available in your area, the SEP allows you to switch from your current plan to that 5-star plan one time between December 8 and November 30 of the following year. This gives you an extra opportunity to move to a top-quality plan outside of the standard enrollment window.

Frequently Asked Questions

Is a 5-star plan always the best choice for me? Not necessarily. While a 5-star rating indicates excellent quality and service, it’s still crucial to ensure the plan’s details fit your personal needs. You should verify that your doctors are in the network, your prescription drugs are on its formulary, and the copays and overall costs work for your budget. The “best” plan is one that has a high rating and meets your specific healthcare requirements.

Do Star Ratings change every year? Yes, they do. CMS collects data and updates the Star Ratings annually every October. A plan that has 5 stars this year might have 4.5 stars next year, and vice versa. It’s always a good idea to check the latest ratings during the Annual Enrollment Period.

Where do I find the official ratings? The only official source for Star Ratings is Medicare.gov and the Medicare Plan Finder tool. While insurance companies will advertise their high ratings, you should always verify them on the official government website.