Medicare Advantage

Medicare Star Ratings: what CMS measures in Fairfax

As the Medicare Annual Enrollment Period approaches on October 15, the Centers for Medicare & Medicaid Services (CMS) is preparing to publish its yearly update to the Medicare Star Ratings. For people in Fairfax weighing their coverage choices this fall, the ratings are one of the clearest, government-produced tools available — but they are often misunderstood.

Fairfax, Va. — What to know about Star Ratings this fall

Star Ratings are not a leaderboard. They are a quality measurement system, and knowing what they actually measure can help you read them the way CMS intends.

What Star Ratings actually measure

Every year, CMS scores Medicare Advantage plans and Medicare Part D drug plans on a scale from one to five stars, with five being the highest. The rating is a summary of dozens of separate measures grouped into broad categories, including:

• Preventive care and screenings, such as how often plan members get recommended checks and vaccines.
• Managing chronic conditions, like diabetes and heart disease follow-up.
• Member experience, based on surveys about how easy it is to get appointments, information, and care.
• Member complaints and problems getting care, including how often people leave the plan.
• Customer service, such as how quickly appeals are handled and how accessible the plan is by phone.
• Drug plan safety and pricing accuracy, for Part D coverage specifically.

In short: Star Ratings measure how a plan performs for the people already enrolled in it — not the plan's benefits, premium, or provider network.

How and when the ratings are published

CMS releases the Star Ratings each fall, ahead of the Annual Enrollment Period that runs October 15 through December 7. Once published, the ratings appear on the official Medicare Plan Finder at medicare.gov, where each plan available in a given ZIP code shows its overall star score.

Fairfax is in Fairfax City, and plan availability — including which Medicare Advantage and Part D plans a resident can choose from — is set at the county level. When you look up plans on Medicare Plan Finder using a Fairfax ZIP code, the Star Ratings you see are tied to the specific contracts offered in that county.

What Star Ratings are not

This is where people sometimes get tripped up. A Star Rating is not:

• A ranking of "best" plans. Two plans can share the same star score and look very different in cost and coverage.
• A prediction of your personal experience. Ratings reflect averages across many members.
• A statement about a plan's price. A higher star score does not mean lower premiums, and a lower score does not mean higher ones.
• A permanent grade. Ratings can move up or down from year to year as performance data changes.

CMS is clear that ratings are meant to be used alongside other information — your doctors, your prescriptions, and your budget — not as a stand-alone decision.

Why the fall release matters this year

The 2027 plan year brings some notable program-level changes that will show up during this enrollment season:

• The Part D out-of-pocket cap is $2,100 for 2026.
• The Part D maximum deductible is $615.
• The old coverage gap, or "donut hole," has already been eliminated as of 2025, leaving three coverage phases.
• The Medicare Prescription Payment Plan lets enrollees spread their drug costs across the year in monthly amounts instead of paying at the pharmacy counter.
• IRMAA income-related surcharges for higher earners begin above $109,000 for single filers in 2026.

With those changes in the background, Star Ratings can help you see how a plan has been performing on service and quality — a useful lens when so much else on the cost side is shifting.

How to use the ratings during AEP

A practical approach during the October 15 – December 7 window:

1. Start at medicare.gov. Enter your Fairfax ZIP code and your prescriptions. 2. Look at the star score, then look past it. Check the categories that matter most to you — customer service, drug safety, chronic care. 3. Compare across years if you can. A plan whose rating has been stable often tells a different story than one that jumped or dropped sharply. 4. Call for help. You can reach 1-800-MEDICARE, 24 hours a day, or contact Virginia Insurance Counseling and Assistance Program (VICAP), the State Health Insurance Assistance Program (SHIP) for Virginia, for free one-on-one counseling.

If you do nothing during AEP, your current coverage generally continues into 2027 with any changes described in your plan's Annual Notice of Change. If you want to switch, changes made by December 7, 2026 take effect January 1, 2027. There is also a Medicare Advantage Open Enrollment Period from January 1 through March 31 for people already in an Advantage plan who want to make a one-time change.