Quick Answer: Should You Switch Plans?
A lower star rating doesn't change your coverage on its own, but it is a signal to compare plans. If your parent's plan is also raising costs, dropping doctors, or changing drug coverage for 2027, use Open Enrollment (October 15 – December 7, 2026) to switch. If you miss that window, the Medicare Advantage Open Enrollment Period (January 1 – March 31) gives one more chance to change. If your current Medicare plan's star rating has dropped, you might be wondering if it's time to switch. This decision is important because it can affect the quality of care you receive and your out-of-pocket costs. Consider factors like the plan's coverage, your healthcare needs, and any changes in costs or services.
Understanding Star Ratings
Medicare Star Ratings measure the quality of Medicare Advantage (Part C) and prescription drug (Part D) plans. The Centers for Medicare & Medicaid Services (CMS) assigns these ratings on a 5-star scale, with 5 being the highest. Ratings are based on factors like quality of care, customer service, member satisfaction, and how well the plan helps members stay healthy. Medicare Star Ratings are updated annually and can be found using the Medicare Plan Finder tool.
These ratings matter because they provide a clear, simple way to understand how different plans measure up. A higher star rating indicates better performance in these areas. However, it's important to consider other factors like premiums, deductibles, provider networks, prescription drug coverage, and out-of-pocket costs when choosing a plan. Medicare Star Ratings encourage health plans to improve quality and member experience through CMS's quality incentive programs.
Impact of a Rating Drop
When a Medicare Advantage or Part D plan's star rating drops, it means the plan's performance in certain areas has declined based on the latest evaluations by the Centers for Medicare & Medicaid Services (CMS). This could affect the plan's overall quality rating and potentially its benefits or costs. However, a drop in star rating does not automatically change your current coverage or benefits. You can still keep your plan if you choose, but you may want to review other options available to you. If your plan's rating drops below 3 stars for three consecutive years, you may qualify for a Special Enrollment Period to switch to a higher-rated plan. For more information on Special Enrollment Periods, visit Medicare.gov.
Ratings also affect a plan's budget. Medicare Advantage plans rated 4 stars or higher get quality bonus payments from Medicare, which many plans use to pay for lower copays or extras like dental and vision. A plan that falls below 4 stars can lose that bonus, so check its Annual Notice of Change (mailed each fall) for benefit cuts or higher costs next year. CMS released the 2027 Star Ratings in fall 2026, and they now appear in Medicare Plan Finder.
When to Consider Switching Plans
When considering a switch in Medicare plans, it's important to evaluate both the costs and coverage of your current plan versus potential new plans. Here's a step-by-step checklist to guide you through the process:
Review your current plan's Medicare Star Rating and compare it with the ratings of other available plans in your area. Medicare Star Ratings
Assess the costs associated with each plan, including premiums, deductibles, and out-of-pocket expenses. Ensure you understand any changes in cost that might occur if you switch plans.
Evaluate the coverage provided by each plan, focusing on the services and medications you need. Check if your current doctors and pharmacies are included in the new plan's network.
Consider any special enrollment periods that may apply to you, such as if your current plan's rating has dropped below 3 stars for three consecutive years. Medicare Advantage Special Enrollment Periods
Consult with a State Health Insurance Assistance Program (SHIP) counselor for unbiased advice and assistance in comparing plans. Find your local SHIP here
Make a decision based on your evaluation, ensuring the new plan meets your health needs and financial situation.
Special Enrollment Periods
Special Enrollment Periods (SEPs) allow you to change your Medicare Advantage or Part D plan outside the regular Open Enrollment Period. One important SEP is the 5-Star Special Enrollment Period, which lets you switch to a 5-star rated plan between December 8 and November 30 of the following year. You can use it once during that period. For the full list of SEPs, visit Medicare.gov. Common situations that qualify include:
Moving to a new area
Losing current Medicare coverage
Gaining other health coverage
Your plan ending its contract with Medicare
Other special situations as defined by Medicare
Medicare Advantage Open Enrollment Period: If your parent is in a Medicare Advantage plan on January 1, they can switch to a different Medicare Advantage plan, or go back to Original Medicare and join a Part D drug plan, one time between January 1 and March 31. This is a useful backup if a rating drop or benefit change becomes clear after Open Enrollment ends.
Common Questions
What do I do if my Medicare Advantage plan's star rating drops? You should review the new rating and compare it with other available plans. If the drop significantly affects the quality of care or your satisfaction, consider switching during a Special Enrollment Period. Learn more about Special Enrollment Periods.
Can I switch plans if the star rating drops below 3 stars? Yes, if your plan's rating drops below 3 stars for three consecutive years, you may qualify for a Special Enrollment Period for Disenrollment. This allows you to switch to a higher-rated plan. Find out more about this period.
How often are star ratings updated? Star ratings are updated annually by CMS. New ratings are typically released before the Open Enrollment Period, which runs from October 15 to December 7 each year. Check the latest ratings.
Should I only consider star ratings when choosing a plan? No, while star ratings are important, you should also consider other factors such as premiums, deductibles, provider networks, prescription drug coverage, and out-of-pocket costs. A comprehensive review will help you find a plan that best fits your needs. Get unbiased Medicare advice from your local SHIP.
Bottom line: Regularly review your plan's star rating and compare it with other options. If a significant drop occurs, explore your Special Enrollment Period options to switch to a plan that better meets your needs. Learn more about your options.
Related reading: 2026 Medicare Open Enrollment: Caregiver's Plan Review and Your 2027 Senior Living Rent Increase Letter: What’s Typical and How to Respond.
This article is general information, not legal or financial advice. Rules and eligibility change, so confirm details with the program or a qualified advisor before making decisions.
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