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Medicare Star Ratings Explained: What the 2026 Sioux Falls Plan Landscape Tells You

Every standard Medicare Advantage PPO in Sioux Falls holds a 3.5-star CMS rating — here's what that number means, what it doesn't, and how to use it.

Big Sioux Benefits Data Desk

Published June 29, 2026 · 10 min read · Sourced from CMS.gov

CMS star ratings are the single most important quality and stability signal published for Medicare Advantage plans — and in Sioux Falls for 2026, every standard plan you can choose lands at the same 3.5-star tier. That uniformity is itself a data point worth understanding before you pick.

Every figure below comes from public federal data: the CMS PY2026 Medicare Advantage and Part D Star Ratings, the CMS PY2026 plan landscape, CMS Hospital Compare, and CMS county enrollment. No invented numbers.

How CMS calculates star ratings: the 5 domains

The CMS Overall Star Rating is not a single measure. It's a composite built from dozens of individual quality metrics organized into five domains. For Medicare Advantage plans that also carry Part D drug coverage — which is every plan available in Sioux Falls — the Part D drug measures fold into the overall score:

Source: CMS Medicare Advantage & Part D Star Ratings (2026). Member experience (CAHPS survey) receives double weight in the composite calculation per CMS methodology.

The member-experience domain — drawn from the annual Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey of actual enrollees — carries double weight in the overall score. That means a plan can have solid clinical metrics and still see its star score pulled down by poor member-satisfaction results. It also means the overall rating reflects real enrollee feedback, not just administrative performance data.

The complete 2026 Sioux Falls plan star-rating landscape

Minnehaha County has 15 drug-carrying Medicare plans for 2026 — 11 Medicare Advantage (Part C) plans and 4 Medica Cost plans, serving 39,532 beneficiaries. Here is the complete roster with CMS star ratings:

Standard Medicare Advantage PPOs — open to any Medicare beneficiary in Minnehaha County

Source: CMS Medicare Advantage & Part D Star Ratings (2026) & CMS Medicare Advantage / Part D Landscape (PY2026), Minnehaha County.

Dual-Eligible Special Needs Plans (D-SNPs) — available only to people enrolled in both Medicare and Medicaid

Source: CMS Medicare Advantage & Part D Star Ratings (2026) & CMS Medicare Advantage / Part D Landscape (PY2026), Minnehaha County.

The 2026 star-rating distribution across all rated Minnehaha County drug plans:

Source: CMS Medicare Advantage & Part D Star Ratings (2026), Minnehaha County, PY2026. Medica Cost plans (4 plans, all 3.5★) included in rated total.

What 3.5 stars means — and what it doesn't

A 3.5-star rating is CMS's published middle tier. Here is an honest read of what it signals:

• Above the termination floor. Plans below 3 stars for three consecutive years can be CMS-terminated. Every 3.5-star plan in Sioux Falls is comfortably above that line.
• Adequate on quality measures. These plans pass CMS's minimum quality thresholds and perform at an average level across preventive care, chronic-condition management, member experience, and customer service.
• Not high-performing. Plans at 4 or 5 stars have demonstrated stronger member outcomes and satisfaction scores. No standard Sioux Falls PPO reaches that tier in 2026.
• Not a tiebreaker between plans. When five plans all share the same 3.5-star rating, the score cannot differentiate them — your network and formulary do that work.

The practical implication: for the 39,532 Minnehaha County Medicare beneficiaries choosing among standard PPOs, star ratings confirm plan quality is adequate — they don't resolve the plan choice. That resolution comes from the Sanford-vs-Avera network question and the cost of your specific medications against each plan's 2026 formulary.

The 4.5-star UHC D-SNPs: the local market's quality standout

Two plans in Minnehaha County reach the 4-star-plus tier: UHC Dual Complete SD-Q1 and UHC Dual Complete SD-S2, both rated 4.5 stars by CMS — the highest overall rating of any plan available in Sioux Falls for 2026.

That rating gap is meaningful on a few levels:

• A 4.5-star score reflects stronger-than-average CAHPS member satisfaction, chronic-condition management outcomes, and customer service performance compared to the 3.5-star standard plans.
• Plans at 4+ stars receive a CMS quality bonus payment, which gives the plan additional resources to fund supplemental benefits and maintain stable premiums.
• The limitation: D-SNPs are not open to everyone. These plans are available only to people enrolled in both Medicare and Medicaid (dual eligibles). If you do not qualify for Medicaid, you cannot enroll in a D-SNP regardless of its star rating.

The two Aetna D-SNPs in the market sit at 3.5 stars — the same tier as the standard PPOs. For dual-eligible beneficiaries, the UHC plans represent a clear quality signal; confirming that your providers and prescriptions align with UHC's 2026 network and formulary is the next step.

Hospital star ratings: the quality benchmark beside your plan

CMS rates hospitals separately through the Hospital Compare program. These scores are independent of plan star ratings — but they are directly connected to your Medicare experience, because the hospital your plan's network routes you to determines the quality of inpatient and outpatient care you receive.

Source: CMS Hospital Compare — Overall Star Ratings.

Sioux Falls has strong hospital quality on both sides of the local health-system divide: Sanford USD Medical Center holds a 5-star CMS Hospital rating and Avera McKennan holds 4 stars — both well above national averages. The Sioux Falls VA Medical Center also holds 5 stars for veteran patients.

The connection to plan choice: Sanford Health operates its own Medicare Advantage plans (the Align lineup). If your primary care and specialists are in the Sanford system, an Align plan often provides the smoothest in-network coordination. If your established care is at Avera facilities, confirming that Avera providers are contracted under any plan you consider is the critical network check. The hospital quality ratings here reinforce that Sioux Falls offers strong options across both systems — the choice is about your specific physicians, not a quality gap between hospitals.

The 5-star SEP: what it is and why no local plan has it in 2026

CMS offers a Special Election Period (SEP) for plans that earn a 5-star rating — enrollees can switch into a qualifying 5-star plan on any day from December 8 through November 30 of the following year, completely outside the standard Annual Enrollment Period windows. It is one of the most valuable enrollment flexibility tools in Medicare.

In 2026, no Medicare Advantage plan in Minnehaha County holds a 5-star rating. That means Sioux Falls beneficiaries wanting to change plans must work within the standard windows:

• Annual Enrollment Period (AEP): October 15 – December 7 each year, effective January 1
• Medicare Advantage Open Enrollment Period (MA OEP): January 1 – March 31, one allowed switch per plan year
• Qualifying Special Enrollment Period: moving out of area, losing other coverage, gaining dual-eligible status, and other CMS-defined life events

If a local plan earns 5 stars in a future rating cycle, it would unlock year-round enrollment for that plan — a development worth watching in each October's AEP rating release.

When CMS acts: the stability and cancellation-risk picture

Star ratings are not only informational — they carry regulatory consequences. CMS publishes clear rules for what happens at the low end of the rating scale:

• Below 3 stars for 3 consecutive years → CMS can terminate the plan's contract. Affected members receive a Special Enrollment Period to choose a new plan, but their network, formulary, and benefits reset.
• Below 3 stars for 2 consecutive years → CMS requires the plan to send an "Immediate Disenrollment" notice to enrollees — a visible public warning.
• Below 2.5 stars in a single year → CMS can restrict new enrollment into the plan immediately.

No standard plan in Sioux Falls is near these thresholds in 2026 — all five PPOs sit at 3.5 stars, and the Medica Cost plans also hold 3.5 stars. But ratings can and do move year to year. A plan that slips from 3.5 to 3 stars enters the watch zone; two consecutive years below 3 stars triggers the enrollee-warning requirement.

The two unrated Sanford I-SNPs carry a different kind of uncertainty: without any CMS performance history, there is no track record to assess. For nursing-home residents evaluating these plans, the absence of a rating is itself information — it means no CMS-published quality benchmark exists yet for those contracts.

How to use star ratings in your 2026 plan decision

Given the uniform 3.5-star landscape in Sioux Falls, here is the practical framework for this year's plan review:

1. Use stars as a quality floor, not a tiebreaker. All local standard PPOs clear the 3.5-star bar. That confirms adequate standing — not which plan is right for your needs.
2. If you qualify for a D-SNP (Medicare + South Dakota Medicaid), the UHC 4.5-star plans represent the strongest quality signal available locally. Confirm your eligibility and compare with the Aetna D-SNP options on network and formulary.
3. Settle the Sanford-vs-Avera question first. Your network preference narrows the field before any other factor — and both hospital systems hold strong CMS ratings in 2026.
4. Run your full drug list. The 2026 Part D out-of-pocket cap is set at $2,100 — the first annual ceiling in Part D history — but formulary tiers and the timing of deductibles still vary significantly among local plans. The cap protects your annual maximum; the formulary decides how you get there.
5. Check October's rating release each year. The 2027 plan-year star ratings drop each October alongside your Annual Notice of Change (ANOC). If your plan's rating changes significantly, that is the right time to do a fresh comparison before auto-renewing.

What to watch for 2027

1. Whether any local standard PPO climbs to 4 stars — a move from 3.5 would trigger a CMS quality bonus and potentially open the 5-star SEP pathway in a subsequent year.
2. The Sanford I-SNP ratings debut — the two Great Plains I-SNPs will receive their first CMS ratings in the 2027 cycle, ending the unrated uncertainty for institutional plan residents.
3. CAHPS survey score shifts — member experience carries double weight in the composite; meaningful improvements in enrollee satisfaction could move the 3.5-star plans upward without major clinical changes.
4. New market entries or plan exits — a carrier entering Minnehaha County could introduce higher-rated competition; a carrier exit would concentrate beneficiaries into fewer options and increase the importance of tracking remaining plan ratings.
5. Part D formulary repositioning — with the $2,100 cap now locking in the annual drug-spending ceiling, plan competition is shifting toward formulary tier positioning; watch whether local plans adjust their drug tiers to attract beneficiaries managing high-cost medications.

How we know all this: Big Sioux Benefits runs every article through a data desk that cross-references the CMS plan landscape, county enrollment, 2026 star ratings, hospital quality data, and CDC health data — built by Strategic AI Architects. Every figure here is from a public federal dataset. This is education, not advice; confirm your plan, costs, and eligibility with a licensed agent or Medicare.gov. We take no payment from any carrier to feature a plan.