What 4 Stars Won’t Tell You

CMS published the 2027 Medicare Advantage and Part D Star Ratings on October 8, 2026, at least one insurer has already announced that most of its members are in plans with four or more stars, and none of that tells you what your plan will cost you next year.

What CMS Published on October 8, 2026, and What a Star Rating Measures

The Centers for Medicare & Medicaid Services (CMS) says it publishes the ratings each year “to measure the quality of health and prescription drug services received by consumers” in Medicare Advantage and Part D plans. The 2027 ratings were posted on Medicare Plan Finder on October 8, 2026, in time for open enrollment. Medicare Advantage plans that include drug coverage (MA-PD) can be rated on up to 43 quality and performance measures, and each measure earns one to five stars (CMS 2027 Star Ratings fact sheet).

Here is the part I’d underline. CMS describes the ratings as quality information that appears in Plan Finder “alongside information about benefits and costs.” Those are two separate kinds of information. I searched the fact sheet, and it does not contain the words premium, deductible, copay or out-of-pocket. A star is a score for how a contract performed. It is not a price tag.

CMS also says the stars are “intended to capture a contract’s performance during the measurement period,” and that “Changes in Star Ratings year-over-year are normal and expected.” So a plan that earned four stars this year is not promised the same score next year, and a plan with fewer stars is not necessarily a bad fit for you, though a low rating is worth asking about.

Insurers can also publish their own tallies. Humana, for one, said on October 9, 2026 that 95% of its Medicare Advantage members are enrolled in plans rated 4.0 stars or above (Humana’s announcement, distributed by Business Wire). That is Humana’s statement about its own members, and I haven’t checked its member counts independently. CMS puts the figure for all MA-PD enrollees at about 71%, so my read is that the stars often will not separate the plans most people are in from each other, though they can still separate a four-star contract from a lower-rated one, and they never separate plans on cost. Your own numbers can.

What a Star Rating Doesn’t Tell You

For someone on a fixed income, these are the things that decide whether a plan turns into medical debt, and none of them is a star:

• The premium. Medicare.gov says Medicare Advantage premiums and other costs, like deductibles, copayments and coinsurance, vary by plan, and that “These amounts can change each year” (Medicare.gov, Costs).
• The deductible and the copays. What you pay for a hospital stay, a specialist visit or a scan is set by the plan, and Medicare.gov lists these amounts as varying by plan.
• The yearly out-of-pocket limit. This is the most a plan can make you pay in a year for covered Part A and Part B services, and it does not include your premiums or your Part D drugs. Medicare.gov says the limit varies by plan.
• Where your drugs land on the plan’s drug coverage. Medicare.gov says Part D deductibles, copayments and coinsurance vary by plan and pharmacy, so the same prescription can cost you different amounts in different plans.
• Whether your doctors and your hospital are in the network. A great score doesn’t help if your cardiologist isn’t in it.

What the 2027 Limit Looks Like in Dollars

For 2027, CMS set the ceiling for a Medicare Advantage plan’s in-network out-of-pocket limit at $9,850 for Part A and Part B services. A PPO that covers out-of-network care can set a combined in-network and out-of-network limit of up to $14,800 (CMS final 2027 Part C bid review memorandum, April 22, 2026, Table 3). Those are ceilings. A plan can set its limit lower, and your plan’s own number is in your Annual Notice of Change and in Plan Finder.

Part D drug coverage has its own yearly out-of-pocket threshold. CMS lists it as $2,400 for 2027 under the standard benefit, up from $2,100 in 2026 (CMS 2027 Rate Announcement, Table V-2). Your drug costs are a separate question from your hospital and doctor costs, which is one more reason the stars can’t answer it for you.

Why This Matters If You Live on a Fixed Income

In a KFF survey fielded from February 25, 2022 to March 20, 2022, 22% of U.S. adults ages 65 and older said they had debt from medical or dental bills. Among older adults with that debt, 62% said they or someone in their household had delayed, skipped or sought alternatives to needed care or prescriptions because of cost in the past year (KFF, health care debt among older adults). That is a survey of what people reported, from 2022, and it isn’t a measure of any one plan. It does tell me this is not a rare problem, and that cost is a real reason people ration care.

Here is the part that surprises people. You don’t have to do anything for your coverage to change. CMS says people who want to keep their current Medicare coverage “do not need to re-enroll,” and it also says the costs and covered benefits of different options “can change from year to year” (CMS 2027 open enrollment fact sheet, September 28, 2026). So staying put is a decision too. It’s the one you make by default if you never open the envelope. One caution from me: all of that assumes your plan will still be offered where you live next year, so open every letter your plan sends.

Medicare Advantage plans must tell enrollees about changes that take effect on January 1, 2027 at least 15 days before open enrollment begins (42 CFR 422.111(d)(2)). Counting back 15 days from October 15, 2026 puts that at about September 30, 2026, which is my arithmetic and not a date CMS prints, and Medicare.gov says the notice goes out in September. If you’re in a plan and that letter never came, Medicare.gov says to contact your plan.

Things to Consider

• Stars can change every year. CMS calls year-to-year changes “normal and expected,” so don’t treat this year’s score as a promise.
• CMS rates contracts, and you buy a plan. The CMS fact sheet counts its ratings by contract (“188 contracts”). A star rating describes how a contract performed during the measurement period, and the premium and copays you would pay are listed plan by plan in Plan Finder and in your notice.
• A denial can cost more than a copay. If a plan has ever denied your care, I wrote about how to appeal in how to appeal when a Medicare Advantage plan denies rehab. Appeals matter whichever plan you choose.
• If you’re also watching your Social Security check, I wrote about the 2027 cost-of-living adjustment and Medicare’s “hold harmless” law in a separate post.
• Help with costs exists, and many people don’t use it. CMS says the Medicare Savings Programs can help pay premiums and may also pay deductibles, coinsurance and copayments if you meet the conditions, yet “only about half of eligible people are enrolled.” Extra Help helps some people pay Part D premiums, deductibles and cost sharing, and the Medicare Prescription Payment Plan lets people with Part D spread drug costs over the calendar year (CMS).

What I’d Think About Doing

You don’t need to master Medicare in a weekend. If you only do one thing, do the first one.

1. Find your Annual Notice of Change and read it

Look for it among the September mail, and call your plan if it never came. It tells you what is changing in your own plan for 2027.

2. Write down your drugs and your doctors

List every medication with its dose, every doctor you see, and the hospital you’d go to. Ten minutes at the kitchen table now saves a lot of phone calls later.

3. Run them through Medicare Plan Finder

CMS says the updated Medicare Plan Finder lets people with Medicare compare their personalized options for health and drug coverage (CMS). Check the plan you have now, not only new ones. That’s the comparison I’d start with. Then call your doctor’s office and ask whether they expect to be in that exact plan’s network in 2027.

4. Compare the real costs, then look at the stars

For each plan, look at the premium, the deductible, the out-of-pocket limit and what your drugs cost. Then use the star rating as one more piece of information. CMS shows the ratings alongside benefits and costs, and looking at the costs first is my ordering.

5. Get free help from a SHIP counselor

State Health Insurance Assistance Programs (SHIPs) give free health insurance counseling, and Medicare.gov says they aren’t connected to any insurance company or health plan. You can find your local one at shiphelp.org. SHIP counselors can help you choose a plan, review coverage, understand costs, apply for Extra Help and file a complaint or an appeal (Medicare.gov, Talk to someone). CMS also says 1-800-MEDICARE is available 24 hours a day, seven days a week.

6. Decide by December 7, 2026

Medicare Open Enrollment runs from October 15, 2026 to December 7, 2026. For the plan to start January 1, 2027, the plan must get your request by December 7, 2026 (Medicare.gov, Joining a plan). December 7, 2026 is not always the last door: the same Medicare.gov page lists a Medicare Advantage Open Enrollment Period from January 1, 2027 to March 31, 2027 for people already in a Medicare Advantage Plan, and Special Enrollment Periods for certain life situations, so ask a SHIP counselor if you miss the date. And if you’re thinking about leaving Medicare Advantage for Original Medicare, ask first whether you could still buy a Medigap policy, because Medicare.gov says that after your Medigap Open Enrollment Period “you may not be able to buy a Medigap policy, or it may cost more.”

If a medical bill is already hurting, don’t wait for open enrollment. Start with A Medical Bill Went to Collections and Nobody Warned Me. Here’s What to Do Right Now, and read Your Hospital Bill Is Probably Wrong. Here Is How to Fight It before you pay a bill you don’t understand. If you’re retired and living on a fixed income, I’m Retired on Fixed Income and Debt Collectors Won’t Stop Calling may help. You can also compare your options with the Find Your Path quiz.

Frequently Asked Questions

When does Medicare Open Enrollment start and end for 2027 coverage?

Medicare Open Enrollment runs from October 15, 2026 to December 7, 2026. Coverage you choose during that period starts January 1, 2027, as long as the plan gets your request by December 7, 2026. If you’re happy with your current coverage, CMS says you do not need to re-enroll.

Does a 4-star Medicare plan cost less than a 3-star plan?

Not necessarily. CMS describes Star Ratings as a measure of quality and performance and shows them in Plan Finder alongside information about benefits and costs, which are separate. Medicare.gov says Medicare Advantage premiums, deductibles, copayments and out-of-pocket limits vary by plan and can change each year, so compare the actual costs for your own drugs and doctors.

What is the Medicare Annual Notice of Change, and what if I didn’t get one?

The Annual Notice of Change (ANOC) is the letter your plan sends each fall listing any changes in coverage and costs that take effect in January. Medicare Advantage plans must send notice of January changes at least 15 days before open enrollment begins. If you’re in a plan and didn’t get yours, Medicare.gov says to contact your plan.

What is the most a Medicare Advantage plan can make me pay in 2027?

For 2027, CMS set the ceiling for a plan’s in-network out-of-pocket limit at $9,850 for Part A and Part B services. A PPO that covers out-of-network care can set a combined limit of up to $14,800. A plan can set its limit lower, the limit does not include your premiums, and Part D drug coverage has its own 2027 out-of-pocket threshold of $2,400, so check your plan’s own numbers.

Where can I get free help comparing Medicare plans?

Your State Health Insurance Assistance Program (SHIP) gives free health insurance counseling and isn’t connected to any insurance company or health plan. Find yours at shiphelp.org. You can also call 1-800-MEDICARE, which CMS says is available 24 hours a day, seven days a week, and ask about the Medicare Savings Programs and Extra Help if money is tight.

This is what I’m telling friends like you over coffee. Take it as input, not instruction, because you know your numbers and I don’t. But remember, you do you.

If you know someone who has a stack of plan letters on the kitchen counter and hasn’t opened them, send them this post. It’s easier to start when you know you’re not the only one.

Consumer debt expert & investigative writer. Personal bankruptcy survivor (1990). Washington Post award-winning author. Exposing debt scams since 1994.