UPDATED Jan. 10, 2019. Each fall, at Annual Enrollment Period (AEP), people compare Medicare plans by contrasting their current Medicare Advantage Plan (and/or Medicare Part D Plan) with other plans on the market. Besides looking for plan’s cost and coverage, you should consider the plan’s quality and performance, but how do you measure quality? It was quite difficult, but not anymore thanks to CMS Star Ratings (also known as Medicare Star Ratings).
The CMS star ratings were introduced as a part of health care reform to improve the quality of care provided by private plans that they contract with Medicare. It scores how well plans perform in several categories. Rating range from one to five stars, with five being the highest and one being the lowest.
Medicare also assigns one overall summary score, known as overall CMS star rating to summarize plan’s performance as a whole. Some plans may be too new to be rated.
A plan’s star rating is calculated each year, and updated results are released each fall.
What do CMS Star Ratings measure?
Medicare Plans’ stars measure how well Medicare plans perform on more than 50 items grouped into different categories. The overall CMS star rating shows the plan’s performance as a whole. You always may ‘drill down’ to the category details, if needed.
Medicare Advantage Plans
The overall score for Medicare Advantage plans cover 36 topics in 5 different categories:
- Staying healthy; screening, tests, and vaccines
- Managing chronic (long-term) conditions
- Member experience with the health plan
- Member complaints, problems getting services, and improvement in the health plan’s performance
- Health plan’s customer service
Medicare Drug Prescription Plans
The overall score for Medicare Drug Prescription plans cover 17 topics in 4 categories:
- Drug plan’s customer service
- Member complaints, problem getting services, and improvement in the drug plan’s performance
- Member experience with the drug plan
- Patient safety and accuracy of drug prices
How to Compare Medicare Plans using CMS Star Ratings
The introduction of the CMS Star Ratings provides simplicity in Medicare plan comparison. Any tools used to compare Medicare plans (such as Medicare Plan Finder) has a star rating associated with any Medicare Advantage or Prescription Drug Plan. Plan’s quality and performance comparison never were easier!
You may use star ratings to compare plans in your service area by categories listed above, or using the overall star rating system. Naturally, in addition to star ratings, you need to consider plan’s benefits and costs, and its network.
Why are Medicare Star Ratings so Important?
Five-star Special Enrollment Period
Five-star Special Enrollment Period (SEP) provides an additional incentive for high-performance plans having overall five-star rating. You may switch to a five-star Medicare Advantage plan without prescription drug coverage, a 5-star Medicare Advantage plan with prescription drug coverage, or a 5-star stand-alone Medicare Prescription Drug Plan at any time during the year. In other words, you are not under the constraints with AEP anymore. You may only use this SEP once per the calendar year. The SEP may be used between December 8 (the day after AEP is over) and November 30 of the following year. You also may switch from one 5-star plan to a different 5-star plan.
Encouraging use of High-Performance Health Plans
Medicare is trying to discourage seniors from using Medicare Health Plans that are performing poorly. It identified Medicare Advantage and Prescription Drug Plans that received low ratings (less than three stars) for three consecutive years. Recently Medicare sent a letter to beneficiaries of those plans urging them an opportunity to switch to a better plan (with 3 or more stars). Officials also warned that poorly performed plans may be canceled in the future.
In addition, Medicare makes it difficult to sign for one of those plans. For example, using Medicare Plan Finder you may access and join the plans electronically, but to enroll in one of the poorly performed health plans the seniors must contact the insurance company directly.
US Government Sources
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