A Guide to Medicare's Highest-Rated Advantage Plans

Searching for the best Medicare Advantage plan can feel overwhelming, but you’re asking the right question by focusing on ratings. Understanding which plans are rated highest is a smart way to narrow your options. We’ll break down what these ratings mean, which companies consistently earn top marks, and how to find the best plan for you.

Understanding the Medicare Star Rating System

The single most important quality measure for Medicare Advantage (Part C) and Prescription Drug (Part D) plans is the Star Rating System. This system is managed by the Centers for Medicare & Medicaid Services (CMS), the government agency that runs Medicare. It’s designed to give you a clear, unbiased look at a plan’s performance.

Plans are rated on a scale of 1 to 5 stars, with 5 stars being the highest possible rating. These ratings are calculated annually and released each fall. A 5-star rating signifies excellent performance and is a significant achievement for an insurance company.

CMS evaluates plans based on dozens of specific factors across several key categories, including:

  • Staying Healthy: How well the plan encourages screenings, check-ups, and vaccines.
  • Managing Chronic Conditions: The quality of care and support for members with long-term health issues like diabetes or high blood pressure.
  • Member Experience: How members rate their satisfaction with the plan, including ease of getting appointments and care.
  • Customer Service: How the plan handles member appeals, questions, and enrollment issues.
  • Drug Safety and Pricing: For plans that include prescription drug coverage, this measures accuracy of pricing and patient safety.

Essentially, a plan with a high star rating has a proven track record of keeping its members healthy and satisfied.

Which Companies Offer the Highest-Rated Plans?

While there isn’t one single “highest-rated plan” in the entire country, many plans achieve the top 5-star rating each year. The availability of these plans is highly dependent on your specific county and state. However, some insurance carriers consistently demonstrate excellence and offer a significant number of 5-star rated plans across the nation.

Based on the 2024 CMS Star Ratings data, here are some of the major insurance companies known for offering highly-rated Medicare Advantage plans:

  • UnitedHealthcare: Often a leader in the field, UnitedHealthcare frequently offers a large number of 5-star plans in various markets, often through its AARP-branded products.
  • Humana: Another major player, Humana consistently receives high ratings for many of its plans, with a strong focus on member satisfaction and care management.
  • Kaiser Permanente: Known for its integrated healthcare model, Kaiser Permanente regularly achieves 5-star ratings in the regions it serves, including California, Colorado, and the Mid-Atlantic states. Their plans are often praised for care coordination.
  • Highmark: A prominent Blue Cross Blue Shield affiliate, Highmark has earned 5-star ratings for many of its PPO and HMO plans, particularly in Pennsylvania and surrounding states.
  • Other Regional Leaders: Many smaller, regional non-profit plans also achieve excellent ratings. Companies like KelseyCare Advantage in Texas and Tufts Health Plan in New England are examples of regional providers that have earned 5-star ratings for their outstanding local service and care.

It is crucial to remember that even within these top companies, not every plan they offer is a 5-star plan. You must check the specific rating for the exact plan you are considering in your local area.

The Special Advantage of a 5-Star Plan

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

Normally, you can only switch Medicare Advantage plans during the Annual Enrollment Period in the fall. However, Medicare rewards excellence by giving you a special, one-time opportunity to switch from your current plan to a 5-star rated Medicare Advantage, Part D, or Medicare Cost Plan available in your area. This SEP runs from December 8th through November 30th of the following year. This means you have a much wider window to move to a top-performing plan if one is available to you.

How to Find the Highest-Rated Plan in Your Area

The most reliable way to find the specific 5-star plans available to you is by using the official Medicare Plan Finder tool on the government’s website. It provides the most accurate and up-to-date information.

Here is a simple step-by-step guide:

  1. Go to Medicare.gov: Navigate to the official Medicare website.
  2. Find the Plan Finder Tool: Look for the option to “Find health & drug plans.”
  3. Enter Your Information: You will be asked for your ZIP code. You can also enter the specific medications you take and your preferred pharmacy to get the most accurate cost estimates.
  4. Select Your Plan Type: Choose “Medicare Advantage Plan (Part C).”
  5. Filter by Star Rating: Once the list of available plans appears, look for a filter option. You can filter the results to show only 5-star plans or plans with 4 stars and higher.
  6. Compare Plans: The tool will show you a list of the top-rated plans in your county. You can then compare their monthly premiums, deductibles, doctor networks, and prescription drug coverage side-by-side.

Beyond the Stars: Other Key Factors to Consider

While a 5-star rating is an excellent indicator of quality, it’s not the only thing that matters. The “best” plan is the one that fits your personal health needs and budget. When comparing top-rated plans, be sure to also check:

  • Network: Are your preferred doctors, specialists, and hospitals in the plan’s network?
  • Total Costs: Look beyond the monthly premium. Consider the annual deductible, copayments for doctor visits, and the maximum out-of-pocket cost.
  • Prescription Drugs: If the plan includes Part D, check its formulary (list of covered drugs) to ensure your medications are included at a reasonable cost.
  • Extra Benefits: Many Advantage plans offer benefits not covered by Original Medicare, such as dental, vision, hearing aids, and fitness memberships.

By using the 5-star rating as your starting point and then evaluating these other factors, you can confidently choose a high-quality plan that works perfectly for you.

Frequently Asked Questions

Do Medicare Star Ratings change every year? Yes, they do. CMS evaluates plan performance annually and releases new ratings each fall. A plan that is 5 stars this year might be 4.5 stars next year, or vice versa. It’s always wise to check the most current ratings during the Annual Enrollment Period.

Is a 4 or 4.5-star plan still a good option? Absolutely. A plan with a 4 or 4.5-star rating is considered high-performing. While a 5-star plan is the gold standard, you may find that a 4.5-star plan in your area offers a better network or lower costs for your specific needs. They are excellent choices and should be seriously considered.

Can I switch to a 5-star plan anytime I want? You get one chance per year to use the 5-Star Special Enrollment Period. The opportunity is available from December 8th through November 30th. If you use it to switch to a 5-star plan in May, for example, you cannot use it again until the next eligibility window opens.