The Medicare Advantage Star Ratings system is used by the Centers for Medicare & Medicaid Services (CMS). It’s a quality rating system with the highest score being five stars. To see a Medicare Advantage companies current CMS Star Rating visit www.medicare.gov/find-a-plan and use the Medicare Plan Finder or call 1-800-MEDICARE.
How the Medicare Advantage Star Ratings is Used
The system rates the quality of all types of Medicare Advantage, also known as MA Plans, including HMO’s, PPO’s, MA Plans that offer prescription drug coverage (MAPD), and stand-alone Prescription Drug Plans (PDP). It is intended to help guide the consumer when choosing their health insurance. By making the rating public, shoppers can consider quality along with price when deciding on coverage.
There is also a financial incentive to the insurance company to perform well. Based on performance, under the CMS Star Ratings, quality bonus payment are paid to the Medicare Advantage and Prescription Drug Plan companies.
Determining the Medicare Advantage Star Ratings
There are five categories of performance used to rate Medicare Health Plans. There are four categories of performance used to evaluate Drug Plans. Medicare uses all the criteria if a plan offers both health and drug benefits, like and MAPD Plan.
Medicare Advantage Stars Rating Categories
1. Staying healthy: This includes whether plan members received screening tests, vaccines, and other check-ups. These are preventative type services to help them stay healthy.
2. Managing chronic (long-term) conditions: Measures how often plan members received certain tests and treatments to help manage their different chronic diseases.
3. Member experience with the health plan: A measurement of overall satisfaction among health plan members.
4. Member complaints and changes in the health plan’s performance: Measures how often Medicare and plan members had problems. Also measures a plans historical performance and improvements, if any.
5. Health plan customer service: Measures appeals by the customer and and its handling.
Prescription Drug Plan Star Ratings Categories
1. Drug plan customer service: Measures appeals by the customer and its handling.
2. Member complaints and changes in the health plan’s performance: Measures how often Medicare and plan members had problems. Also measures a plans historical performance and improvements, if any.
3. Member experience with the drug plans services: A measurement of overall satisfaction among health plan members.
4. Drug safety and accuracy of drug pricing: Measures the accuracy of a drug plan’s pricing and the safety, as well as the accuracy of prescribing drugs as clinically recommended.
Star Ratings and Your Medicare Advantage or Prescription Drug Plan
A plan’s star rating should not be your only consideration when looking for coverage. Be certain the MA, MAPD or PDP Plan meets your needs as well. Such as, are your prescription drugs covered? Are you satisfied with the plans pharmacy and hospital network? Can you keep your current doctor? Unlike Medicare Supplements, Medicare Advantage Plans are not standardized. Coverage can vary drastically between the different plans and companies. Be sure you understand exactly how a plan works before making your final decision.
Five Star Special Enrollment Period (SEP)
Medicare uses all of this information to rate Medicare Advantage and Prescription Drug Plans between one and five stars. Each year, plan enrollees have the one-time option to switch from a lower rated plan to a five-star plan. This Special Enrollment Period (SEP) occurs between December 8th and November 30th.