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What are Medicare star ratings?

The Centers for Medicare & Medicaid Services (CMS) rates all Medicare Advantage and prescription drug plans each year to help Medicare beneficiaries and their families compare plans based on quality and performance. The Medicare star ratings are based on how well Medicare Advantage plans deliver medical coverage, prescription drug services, customer service, and how current members rate their satisfaction with the plan. You can use these scores to compare our quality and performance to other Medicare plans.

How do Medicare Star Ratings work?

5 out of 5 Stars for HMO and PPO

5 out of 5 Stars for HMO and PPO

Every year, Medicare (CMS) evaluates plans based on a 5-star rating system. CMS uses up to 40 quality and performance measures to rate plans. Ratings range from a low “1” star, which is poor, to the highest possible “5” stars, which is excellent. Medicare’s 5-star rating is given by CMS, the federal program that governs all Medicare plans, which means it cannot be paid for—it must be earned.

The number of stars shows how well a plan performs.

  • 5 out of 5 stars Excellent
  • 4 out of 5 stars Above Average
  • 3 out of 5 stars Average
  • 2 out of 5 stars Below Average
  • 1 out of 5 stars Poor

The areas CMS uses to determine star ratings include:

  • Feedback from members about the plan’s service and care
  • The number of members who left or stayed with the plan
  • The number of complaints Medicare got about the plan
  • Data from doctors and hospitals that work with the plan

Why are the Medicare star ratings important?

More stars mean a better plan—members get better care, better quality, and better customer service. Medicare beneficiaries can use this score to compare quality and performance of Medicare plans. This important tool can help beneficiaries choose the best Medicare plan to fit their needs.

How to find and enroll in a 5-star Medicare plan

All UPMC for Life HMO and PPO plans have been rated 5 out of 5 stars by Medicare for 2023. You can shop our Medicare plans and connect with a Medicare Advisor to enroll today! If your current Medicare plan is not a 5-star plan, you can change your plan. You can enroll in a 5-star rated Medicare Advantage plan from UPMC for Life during the Annual Enrollment Period from Oct. 15 through Dec. 7. Because UPMC for Life is a 5-star rated plan, you could also be eligible for a Special Election Period (SEP) to enroll from Dec. 8, 2022, to Nov. 30, 2023. You can change from another Medicare Advantage plan, Original Medicare, or a Part D Prescription drug plan.

UPMC Health Plan’s 5-star Medicare plan

UPMC for Life has earned an excellent 5 out of a possible 5 overall star rating for both its HMO and PPO plans from the Centers for Medicare & Medicaid Services (CMS) for 2023. We’ve also received Accreditation from the National Committee for Quality Assurance (NCQA)!

These awards place us among the highest-rated Medicare plans in the nation. The ratings are based on how well Medicare Advantage plans deliver medical coverage, prescription drug services, customer service, and member satisfaction. You can use these scores to compare our quality and performance to other Medicare plans.

There is still time to join our 5-star Medicare plan!

If you missed the Annual Enrollment Period (AEP), it’s not too late to get better coverage from UPMC for Life. Because UPMC for Life received 5 stars from Medicare, you could be eligible for a Special Election Period (SEP) to enroll in a UPMC for Life plan from Dec. 8, 2022, to Nov. 30, 2023. You can change from another Medicare Advantage plan, Original Medicare, or a Part D Prescription drug plan.

Find a UPMC for Life Medicare plan that best fits your needs

Best service

UPMC Health Plan earned 12 awards during the 16th annual Stevie® Awards for Sales & Customer Service event for outstanding customer service and innovation in 2022.

The Stevie Awards for Sales & Customer Service are the world’s top honors for customer service, contact center, business development, and sales professionals across organizations of all sizes and in virtually every industry.

For the second year in a row, UPMC Health Plan was a GRAND STEVIE winner for overall best Sales and Customer Service!

To our members…

Thank you to our members for helping us achieve these awards! You may not realize it, but our excellent star rating and accreditation are thanks in large part to you! These scores reflect our commitment to offering the best possible care and coverage to our members every day. We could not have accomplished such a great score without you, and we are so thankful to serve each and every one of you!

This information is not a complete description of benefits. Call 1-866-400-5077 (TTY: 711) for more information. Out-of-network/Noncontracted providers are under no obligation to treat UPMC for Life members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services. Other physicians/providers are available in the UPMC for Life network.

This information is available for free in other languages. Please call our customer service number at 1-877-539-3080 (TTY: 711).

UPMC for Life has a contract with Medicare to provide HMO, HMO SNP, and PPO plans. The HMO SNP plans have a contract with the PA State Medical Assistance program. Enrollment in UPMC for Life depends on contract renewal. UPMC for Life is a product of and operated by UPMC Health Plan Inc., UPMC Health Network Inc., UPMC Health Benefits Inc., and UPMC Health Coverage Inc.

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UPMC for Life Members
Call us toll-free: 1-877-539-3080
TTY: 711

Oct. 1 – March 31:
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Last Updated: 9/6/2023