Definition
Medicare Star Ratings
Medicare Star Ratings are CMS scores, from 1 to 5 stars, that rate Medicare Advantage and Part D plans on quality of care, member experience, and customer service. They are built largely from HEDIS, CAHPS, and pharmacy measures. Higher ratings earn quality bonus payments and attract enrollment, so plans work continuously to improve them.
Definition
What Medicare Star Ratings are
Medicare Star Ratings are annual CMS ratings, on a 1-to-5 scale, for Medicare Advantage and Part D prescription drug plans. They summarize dozens of individual measures spanning clinical quality (many drawn from HEDIS), member experience (from CAHPS surveys), medication adherence, and customer service.
The ratings carry real money. Plans that reach 4 stars or higher qualify for quality bonus payments and can reinvest in richer benefits, and a higher public rating drives enrollment during the Annual Enrollment Period. A drop of half a star can move millions of dollars, so plans manage the underlying measures all year.
The measures that move stars are, at bottom, completed patient actions: closed screening gaps, controlled chronic conditions, and refilled prescriptions. Rivvi runs the outreach behind those, care-gap recalls, wellness-visit booking, and medication-adherence programs, as real conversations that book and confirm, then write the result back.
Star Ratings, answered
- What do Medicare Star Ratings measure?
- They measure the quality and member experience of Medicare Advantage and Part D plans across dozens of metrics: clinical quality (many from HEDIS), member-experience surveys (CAHPS), medication adherence, and customer service. CMS combines these into an overall 1-to-5 star score published each year.
- Why do Star Ratings matter to a health plan?
- Plans rated 4 stars or higher earn CMS quality bonus payments and can offer richer benefits, and a higher public rating attracts enrollment during the Annual Enrollment Period. Because a fraction of a star can shift substantial revenue, plans actively manage the underlying quality and adherence measures.
- How does medication adherence affect Star Ratings?
- Several high-weight Star measures are pharmacy adherence measures, such as the share of members consistently taking statins, diabetes medications, or blood-pressure drugs (measured by PDC). Improving refill and adherence rates lifts those measures, which is why pharmacies and plans prioritize adherence outreach.