Understanding Medicare Star Ratings for Plans in Vermont

When choosing a Medicare Advantage (Part C) or Medicare Part D (prescription drug) plan, cost and coverage are often the first things people think about. But another critical factor is quality, and that’s where Medicare Star Ratings come in. These ratings, assigned by the Centers for Medicare & Medicaid Services (CMS), help current and future Medicare beneficiaries compare how well different plans perform. In this article, we’ll explain what star ratings are, how they are calculated, why they matter, and how they can influence your care.

What Are Medicare Star Ratings?

Medicare Star Ratings are a system used by CMS to rate the quality of Medicare Advantage plans (Part C) and standalone prescription drug plans (Part D). Plans are rated on a scale from 1 to 5 stars, with 5 stars being the highest possible quality.

“Medicare star ratings is a system used by CMS to rate Part C and Part D plans. They are based on clinical care, customer satisfaction and the performance of the plan,” says Constance Phillips, a licensed Medicare agent in Ohio. “For example, 5 star plans have excellent performance and may also have special opportunities for enrolling. The star ratings help clients compare costs, coverage and quality of plans.”

These ratings are published every fall (usually around October) and appear in tools like the Medicare Plan Finder, so beneficiaries in Vermont can compare plans side by side.

How Are Medicare Advantage Star Ratings Calculated in the State of Vermont?

CMS evaluates each Medicare plan on a variety of performance measures, and these measures differ depending on whether the plan is Medicare Advantage or a Part D drug plan.

• Medicare Advantage (Part C) plans are rated on up to 40 different measures.

• Part D (drug) plans are evaluated on fewer measures — up to 12 — but each is carefully chosen to reflect key aspects of drug coverage.

These measures fall into categories such as:

1. Preventive care and screenings… for example, how many enrollees get cancer screenings or flu shots.

2. Managing chronic conditions… how well a plan supports members with chronic illnesses like diabetes or heart disease.

3. Member experience… customer survey data about satisfaction, ease of getting appointments, or finding a doctor.

4. Member complaints and plan performance… how many grievances are filed, how often people leave the plan, how appeals are handled.

5. Customer service… how quickly a plan handles phone calls, whether services are available in other languages, etc.

Plans are also increasingly judged on whether they address the non-medical factors that drive most health outcomes. According to Melanie Blackston, a licensed Medicare agent in South Carolina, “Social Determinants of Health—such as housing, food security, and transportation—drive up to 80% of health outcomes. In Medicare, plans increasingly incorporate SDOH screening and support to reduce costly hospitalizations, advance health equity, and boost their official quality and star ratings.” That said, SDOH measures are still an emerging influence on star ratings rather than a dominant input—the bulk of a plan’s score continues to come from traditional clinical, satisfaction, and operational metrics.

Each year, CMS sets "cut points" for these measures, which determine how high a plan’s performance must be to earn each star level. These cut points are recalculated annually based on how plans performed, so the standards may shift over time. Staying informed about upcoming changes to Medicare can help you understand how ratings and plan options in Vermont may evolve.

Why Do Star Ratings Matter to You?

Star ratings matter because they give you a quick way to compare the overall quality of Medicare Advantage and Part D plans in Vermont. A higher rating usually reflects better performance in areas like customer service, preventive care, prescription drug safety, and member satisfaction. They can also be a signal about the kind of provider network you’ll have access to. “The higher the star rating the better the care, because the company can partner with doctors and specialists that take pride in caring for their patients,” says Frances Eleanor Mitchell, a licensed Medicare agent in Florida. Keep in mind that ratings reflect aggregate plan performance, so your personal experience will still depend on the specific doctors you see and the plan variant you choose.

These ratings can also affect your enrollment options. For example, if a plan consistently scores below 3 stars, you may qualify for a Special Enrollment Period that lets you switch to something better. On the flip side, top-rated plans unlock a unique enrollment window of their own. “The 5-Star Special Enrollment Period runs December 8th to November 30th,” says Jennifer Milton, a licensed Medicare agent in Texas. “It is a unique opportunity for Medicare beneficiaries to enroll in an Advantage plan or Part D prescription drug plan” that has earned the top rating in their area. High rated plans may also receive bonus payments from Medicare, which can support improved benefits or lower costs. While ratings do not show everything about a plan, they offer a helpful snapshot of how well a plan serves its members.

What a Star Rating Does Not Guarantee

Even though star ratings are useful, they are not the whole story. Here are some important caveats:

• Star ratings are based on contracts, not individual plan options. A single contract may cover many plan variants, so a 4 or 5 star contract does not guarantee every plan under that contract is perfect for your needs.

• The ratings use survey data, which can reflect how satisfied people feel. However, “satisfaction” does not always mean cost-effectiveness or that your specific doctors are in network.

• Cut points (what it takes to earn stars) change every year. A plan that had a certain rating in past years could shift up or down.

• A very low-star plan might give you a Special Enrollment Period, but switching plans always means looking carefully at coverage, cost, and networks, not just the stars. Be sure to review how much Medicare costs in 2026 and whether dental coverage or other benefits are included before making a switch.

How to Use Star Ratings to Make Your Decision

When comparing Medicare plans in Vermont, use star ratings as a starting point to understand overall quality, then look deeper at the details that matter to you. A higher star rating can signal good performance, but you should still check whether your doctors are in network, your prescriptions are covered, and the costs fit your budget. Jacqueline Proffit, a licensed Medicare agent in Florida, recommends pairing the CMS rating with other due diligence: “Ensure your preferred doctors, specialists, and local hospitals are in-network. Out-of-network care can result in massive, unexpected out-of-pocket expenses.” She also suggests checking independent financial strength ratings from agencies like A.M. Best, S&P, or Moody’s alongside the CMS stars, since a carrier’s long-term stability matters as much as its current performance score. Understanding Part A costs, premiums, and deductibles alongside star ratings gives you a more complete picture of plan value. Looking at how a plan’s rating has changed over time can also help you spot trends, such as improving care or declining service. If your current plan has a low rating for several years, you may be able to switch during a Medicare Advantage enrollment period. Star ratings are a helpful guide, but they work best when used alongside your personal health needs and financial considerations.

Letting the Stars Align (for You)

Medicare Star Ratings are a powerful tool for comparing the quality of Medicare Advantage and Part D plans in Vermont. They reflect real measures of customer satisfaction, preventive care, chronic illness management, and more. While star ratings should not be the only factor in your decision, they can provide insight that goes beyond just cost or benefits. Understanding when you can change your Medicare plan during Open Enrollment is equally important for acting on what the ratings reveal. Whether you are signing up for Medicare for the first time, reviewing Medicare eligibility requirements, or considering switching from Medicare Advantage to Medigap, star ratings can help guide your decision. You may also want to review how Medicare Advantage plans compare and learn about Medicare Part D options before finalizing your choice. By using the Medicare Plan Finder and understanding what goes into those stars, you can make more informed decisions that may improve both your care and your peace of mind.