Understanding the Medicare Star Rating
- Medicare rates Medicare Advantage and Part D (prescription drug plans) by stars.
- A 5-star rating is the best while a 1-star rating is the worst.
- Medicare takes a variety of variables into account when determining the rating, including plan participants’ ratings and member complaints.
What do Medicare star ratings mean?
Mar 03, 2022 · The Medicare star rating system measures how well Part C and Part D plans perform in several categories. The highest rating a plan can get is 5 stars and 1 star is the lowest rating. Medicare will review plan performances every year and assign new star ratings in the fall.
Why are Medicare star ratings important?
How Medicare Star Ratings Work. The Centers for Medicare and Medicaid Services (CMS) uses a star rating system for Medicare Part C and Part D plans. Medicare Part C is also called Medicare Advantage, and Medicare Part D covers prescription drugs. Medicare star ratings range from one to five stars; they measure the performance and quality of Medicare Advantage plans and …
What is Medicare 5 star rating system?
Sep 17, 2020 · The Medicare Stars is a rating system developed by the Centers for Medicare & Medicaid Services (CMS). The system rates Medicare Advantage (MA) and Prescription Drug (PDPs or Part D) plans on a 5-star scale with 1 being the lowest and 5 being the highest score. Measurements focus on health plan quality based on measurements of customer satisfaction …
What are star ratings for health plans?
Jan 31, 2022 · How the Medicare Star Rating System Works The Medicare Star Rating System measures the performance of plans based on several categories including quality of care and customer service.
How are star ratings calculated?
What are the Medicare Stars measures?
How can a Medicare beneficiary use the star ratings?
How do I increase my star rating for Medicare Advantage?
How often are Medicare star ratings calculated?
What is star rating program?
How do star ratings affect reimbursement?
Who sets the standards for Medicare star ratings?
Why are star ratings important to Medicare Advantage plans?
What is the 5 star rating system?
Key Takeaways
Medicare Star Ratings were developed to give people more information to consider when choosing a health or prescription drug plan.
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What is the Medicare star rating system?
What Is the Medicare Star-Rating System? The Medicare Star-Rating System is a method for consumers to evaluate and compare Part D drug plans and Medicare Advantage Plans, which vary greatly in terms of cost and coverage. Medicare reviews the performance of plans one a year and publishes new star ratings each fall.
How to find Medicare star rating?
You can find a plan's star rating using Medicare's Plan Finder tool or by calling 1-800-MEDICARE.
Can you switch to a five star Medicare Advantage plan?
In general, you can change your plan or enroll in a new one only during a Special Enrollment Period. You can use an SEP to join or switch to a five-star Medicare Advantage or Part D plan. However, a SEP can only be used once a year.
Does Medicare Part D change?
Each January, Medicare Part D drug plans and Medicare Advantage Plans can change their coverage and costs for the new calendar year. Therefore, users of the plans should review their coverage and compare their plans with other available plans to ensure their coverage is optimal.
How are Medicare Advantage Plans rated?
According to Medicare Interactive, Medicare Advantage Plans are rated on their performance in the following five different categories: 1 . Staying healthy: screenings, tests, and vaccines. Managing chronic (long-term) conditions. Plan responsiveness and care.
When can Medicare change plans?
Enrollees can change plans during specific times or during Special Enrollment Periods (SEP), which are times outside normal enrollment periods that are triggered by specific circumstances.
Measures, domains for star ratings
CMS assesses a Medicare Advantage plan’s quality of care according to the plan’s performance on a list of quality measures. Each measure falls under one of nine domains. The domains include maintaining health, chronic disease management, member experience, member complaints, and customer service as well as four domains for scoring drug plans.
Categorical adjustment index
The fact that stars are assigned to contracts and not individual plans could pose a problem for contracts that cover a diverse set of Medicare Advantage health plans.
Adjustments for stable, high performance
Additionally, CMS has incorporated an improvement measure for plans that receive high scores multiple years in a row. Consistently high-scoring plans would receive a lower star score in successive years because they have less room for improvement.
Quality bonus payments
As a result of the data collection and calculations involved in this methodology, the Medicare Advantage Star Rating system helps consumers compare Medicare Advantage plans. It also informs CMS how much to reimburse payers with Medicare Advantage contracts.
How does Medicare's star rating system work?
You could choose from a wide range of Medicare Part C (now known as Medicare Advantage) plans as early as 1997. But you didn't have a good way to compare them until 2008. That's when the Centers for Medicare & Medicaid Services (CMS) first rolled out the star rating system.
What parts of a health insurance plan are rated?
The way that the CMS rates healthcare plans depends on what type of plan it is.
What is the standard rating for a Medicare plan?
Most Medicare plans have a good rating these days, but not all. According to the CMS, nearly 68% of Medicare plans with prescription drug coverage (MA-PDP) in 2022 have a four-star rating or higher. That’s up from 49% in 2021.
How to use the rating system to pick the best health insurance plan
In general, it's best to choose the highest-rated plan that you can afford. You can compare plans and their ratings on the Medicare Plan Finder website. On the Plan Finder tool, each plan has an overall star rating based on all the rated categories.
The bottom line
Choosing between different Medicare plans can be tough. But the star ratings can help you identify high-performing ones and those with higher scores in categories that may matter to you. The CMS rates each plan on up to 40 different factors to create a helpful picture of how well the plan treats its members and their healthcare needs.
What Are Medicare Star Ratings?
Medicare star ratings are an objective way for consumers to compare private Medicare Advantage plans and Medicare Part D prescription drug plans based on quality and performance.
CMS Star Ratings for 2022
The overall star ratings for Medicare Advantage prescription drug plans (MA-PD) have improved in recent years. According to CMS, about 68% of MA-PD plans earned four stars or higher in 2022 — a 19% increase from 2021.
What Do Medicare Star Ratings Measure?
Medicare Advantage plans and Part D plans are measured differently within the star rating system. But each plan rates various measures within the following categories:
How To Find a 5-Star CMS Health Plan
You can use CMS’s plan finder tool or call 1-800-MEDICARE to compare ratings and find the best plans in your area. Since plan quality ratings are updated every year, be sure to check the most up-to-date ratings for a more accurate comparison.
What Is the 5-Star Special Enrollment Period?
The 5-star special enrollment period allows you a one-time opportunity to switch to a 5-star plan in your service area between December 8 and November 30.
