Five-star ratings matter when you’re taking a chance on dim sum from a strip mall. Nobody wants to gamble on bad dumplings.
Mom’s Medicare Advantage plan has stars, too. Except those come from the federal government, and the stakes are considerably higher than takeout.
Last week we covered Open Enrollment. This week: what those stars measure, how insurers get paid for them, and what it all means for Mom.
Source: Today’s Parent
ICYMI
🤘 At 99, Pauline Kana broke the Guinness World Record for oldest crowd surfer after being carried above a concert crowd for more than three minutes, proving that retirement at 83 was just the beginning of her second act.
💰 Social Security benefits will increase by 3.6% in 2027, giving nearly 72 million Americans a cost-of-living adjustment averaging an extra $75 per month for retirees, with payments beginning in January.
⛰️ At 90, Nevada resident Jim Scott climbed Mount Kilimanjaro for the second time, nearly 45 years after his first ascent.
🎬 Hollywood’s 90-plus crowd is still going strong, and People takes a look at some of its biggest stars, then and now.
Seeing Stars
More than 3 million people are losing their Medicare Advantage plans for 2027, according to CNN, UnitedHealthcare, Humana, Aetna, and Centene are all cutting plans or pulling out of counties.
Rising medical costs and tighter federal payments are behind most of the cuts. But there’s another factor most families rarely hear about: a federal star rating worth billions to insurers. Plans that earn enough stars collect bonuses. Plans that fall short are first in line to get tossed like yesterday’s leftovers.
The Centers for Medicare & Medicaid Services (CMS), the federal agency that runs Medicare, rates every Medicare Advantage plan once a year from one to five stars. The score draws on dozens of measures, including:
Staying healthy: cancer screenings, vaccines, annual checkups
Chronic conditions: how well the plan helps manage diabetes, blood pressure, and other ongoing conditions
Drug safety: whether members take medications as prescribed, and whether risky combinations get flagged
Member experience: surveys asking real members how easy it was to see a doctor or get care approved
Customer service: complaints, appeals, and how many members leave the plan
Medicare pays Advantage insurers a set monthly amount for each member, adjusted for how healthy or sick that member is. The starting point is a benchmark based on what Original Medicare spends on people in Mom’s county.
Stars increase that check in two ways:
A higher ceiling. Plans with four stars or more get a 5% bump to their benchmark, and 10% in some counties.
A bigger rebate. Each insurer bids what it expects covering Mom will cost. If the bid comes in under the benchmark, Medicare sends back part of the difference. Better stars earn a bigger cut: 70% for plans rated 4.5 stars or higher, 65% for 3.5 to 4 stars, and 50% for plans rated three stars or lower.
Added up, those quality bonuses will cost Medicare at least $13.4 billion in 2026, according to KFF, a nonpartisan health policy research group. For perspective, in 2015, it was $3 billion.
The bar keeps rising. CMS has tightened its scoring, and only 37% of rated contracts earned four stars or more for 2027, down from 44% a year earlier. The 2027 ratings came out October 8 and set bonus payments for 2028.
Stars also help decide which plans survive. Humana told investors its 2027 exits target plans rated 3.5 stars or lower.
All that bonus money is supposed to reach Mom. Insurers have to spend their rebates on members, through extras like dental, vision and hearing coverage, gym memberships, lower copays, or a $0 premium. A plan with fewer stars has less to go around.
You’ll find every plan’s rating on Plan Compare (you may also see it called Medicare Plan Finder), Medicare’s official plan-shopping tool. Medicare rates in whole and half stars. Here’s how to read the score:
5 stars: Rare. Only 15 contracts earned it for 2027. If one is available near Mom, she can switch into it once a year, almost any time, instead of waiting for Open Enrollment.
4 or 4.5 stars: Where most people are. The plan earns bonuses, which usually means more money for extras.
3 or 3.5 stars: Below the pack, not a crisis. The plan gets no bonus, and plans in this range are more likely to be cut. Click into the detailed scores and look at the categories Mom cares about, like getting appointments, complaints, and drug coverage.
2.5 stars or lower: Look closely. Three years in a row below three stars earns a red warning icon, and Medicare will send her a letter. That’s the moment to compare other plans.
No stars yet: The plan is too new to be rated. That’s not a red flag, but there’s no track record to go on.
A little extra credit worth knowing, whether Mom’s plan is staying or going:
The grade isn’t always about her plan. Medicare scores the insurer’s contract, and one contract can cover many plans across several states. Mom’s rating may reflect members who live nowhere near her.
Stars don’t check her doctors. A five-star plan that drops Mom’s cardiologist is a bad plan for Mom. Use the stars to narrow the list, then check her doctors, prescriptions, and pharmacy.
A canceled plan doesn’t mean canceled Medicare. If Mom’s plan is ending, she should have received a nonrenewal notice by early October. It’s a different letter from the Annual Notice of Change we flagged last week. If she does nothing, she’ll be moved to Original Medicare on January 1, with no drug coverage and no Medigap. That means no cap on what she pays out of pocket.
She has extra time. Open Enrollment ends December 7, but people whose plans are discontinued get a special window from December 8 through February 28. Choosing a new plan by December 31 avoids any gap in coverage.
She may get a rare second shot at Medigap. Last week we warned that in most states Medigap insurers can review Mom’s health and charge more or turn her down. A canceled plan is one of the exceptions. When an Advantage plan ends, federal law gives her a guaranteed issue right: she can buy certain Medigap policies, and insurers can’t refuse her or charge more because of her health history. The window opens 60 days before her plan ends and closes 63 days after. It only applies if she returns to Original Medicare. Picking another Advantage plan doesn’t use it. Some states go further than federal law. KFF breaks it down by state.
Overwhelmed by the Medicare Advantage menu? Here’s the order:
Find the letter. A nonrenewal notice means the plan is gone. An Annual Notice of Change means it’s staying but changing.
Look up her plan’s stars. On Plan Compare, check the overall rating, the detailed scores and whether there’s a warning icon. Then plug in her prescriptions and pharmacy, and call her doctors’ offices to confirm they take the plan.
Price both paths. If her plan is ending, compare another Advantage plan against Original Medicare plus Medigap plus a Part D drug plan while her guaranteed issue window is open.
Protect her prescriptions. If she’s heading to Original Medicare, get a Part D plan in place before January 1.
Get free help. Every state has a State Health Insurance Assistance Program (SHIP) with free, unbiased counseling. Find one at SHIP Help or call 1-800-MEDICARE.
Pop Quiz
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Parenting Parents
You said it. This week’s submissions.
"Can't decide if my mom is resentful, sad, or doesn't get that my dad has late stage Alzheimer's."
"Been making excuses to not visit my mom because it's so, so sad. Feeling guilty."
"Friend gave me work space so I could prep for my dietetic internship without distractions."
"I've been caregiving so long that my friends now ask me for advice."
"Dad fell and broke his hip this week and Mom is still recovering from her TBI..."
"Finally went on a real vacation with my husband and kids. Had to arrange 6 different people to help out while I was gone."
