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. Each plan receives a rating — weighted by enrollment numbers — between 1 and 5 stars, with 1 being poor and 5 being excellent.
What do those Medicare star ratings mean?
What Medicare star ratings mean A Medicare star rating is a plan’s overall performance and quality score that's calculated across a wide range of criteria including customer satisfaction, access to health care and the rate of receiving preventative care.
What does a 5-star Medicare rating mean?
A 5-star rating is the highest rating or considered "excellent." The star rating is defined as the overall rating of plan quality and performance. Star ratings are calculated each year and may change from one year to the next. For 2021 Star Ratings a total of 28 Medicare plans earned 5 stars.
What do the Medicare nursing home star ratings mean?
The overall star rating for nursing homes lets you compare nursing homes on topics you consider most important, and gives you a “snapshot” of the quality of each nursing home. The rating, between 1 to 5 stars, combines results and data from 3 important sources, including:
Do new Medicare plans have star ratings?
Star Ratings are also awarded for various discrete aspects of Medicare Part D and Medicare Advantage plans. New Medicare Part D or Medicare Advantage plans naturally do not have any historical information, so they will not have any Star or quality ratings for the first year.
What is a Medicare star rating?
Medicare uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Medicare scores how well plans perform in several categories, including quality of care and customer service. Ratings range from one to five stars, with five being the highest and one being the lowest.
What are star ratings important to Medicare Advantage plans?
Medicare star ratings are important because they give you an idea about which plans in your area have the highest satisfaction ratings. Star ratings only pertain to Medicare Advantage and Part D plans. For both types of coverage, the ratings provide a way to compare your plan options beyond their cost.
How are Medicare stars calculated?
The Medicare Advantage Star Rating system assigns up to five stars to health plans based on their members' health outcomes. Plans that receive a four or five star rating exhibit high-quality care. Plans that receive a lower star rating did not perform as strongly.
How often are Medicare star ratings calculated?
each yearStar Ratings are calculated each year and may change from one year to the next. If you're enrolled in a Medicare plan, you should check your plan's Star Rating every fall.
What is the purpose of star ratings?
Star rating is a method of grading accommodation to help customers make a choice that best suits their needs and budget. The rating system was introduced initially for hotels by motoring organisations like the AA (Automobile Association) and RAC (Royal Automobile Association) as early as 1912.
How do star ratings work?
Summary star ratings are an average of a provider's question level star ratings. Patient star ratings are calculated by dividing the patient's aggregate mean score by 20. For clients using only one question in the patient star rating, the star rating would simply be the individual question score, divided by 20.
How do I increase my star rating for Medicare Advantage?
7 Ways to Improve Your Star RatingEnsure Medication Benefits Are Central to the Consumer Onboarding Experience. ... Develop Targeted Outreach Programs Around Medication Adherence and Preventive Screening. ... Make Every Interaction Count. ... Be Proactive with Consumer Feedback. ... Communicate Consistently and in Different Channels.More items...•
What is a star rating system?
Star classification is a type of rating scale utilizing a star glyph or similar typographical symbol. It is used by reviewers for ranking things such as films, TV shows, restaurants, and hotels. For example, a system of one to five stars is commonly used in hotel ratings, with five stars being the highest rating.
Who sets standards for Medicare star ratings?
The Centers for Medicare & Medicaid Services (CMS) publishes the Medicare Part C and D Star Ratings each year to measure the quality of health and drug services received by beneficiaries enrolled in Medicare Advantage (MA) and Prescription Drug Plans (PDPs or Part D plans).
Do new plans have star ratings?
New contracts do not have the historical performance information necessary to determine a Star Rating, so they are temporarily assigned a 3.5% bonus payment for the first three years. After three or more years, contracts begin to receive a Star Rating based on their historical performance.
How are Medicare plans rated?
The Centers for Medicare and Medicaid Services uses a star rating system to evaluate Medicare Advantage plans and Medicare Part D plans. Plans can...
Which Medicare plans received 5-star ratings for 2022?
For 2022, there are a total of 87 Medicare contracts nationwide that have a 5-star rating (a significant increase from the 28 Medicare contracts th...
How has the COVID pandemic affected Medicare star ratings?
Due to the pandemic, the federal government had to contend with the fact that a significant amount of the data used for star ratings could not be c...
What are CMS Medicare star ratings based on?
Medicare star ratings are calculated using 40 criteria across Part C and Part D coverage. This includes survey data about member satisfaction, calc...
What does a CMS 5-star rating mean?
A 5-star Medicare plan has earned the best-possible rating for quality and performance. If a 5-star plan is available in your area, you can switch...
What is the highest rating for a Medicare Advantage plan?
A 5-star Medicare Advantage plan has the highest possible rating. Plans are ranked on a scale of 1 star to 5 stars. Only 16% of contracts have achi...
Can you get a $0 Medicare Advantage plan with 5-stars?
Yes, in 92% of the counties where 5-star plans are available, you can get a free Medicare Advantage plan that also has 5 stars. However, the cost o...
Why are star ratings important when choosing a Medicare plan?
Medicare star ratings tell you about a plan's quality and performance across a range of criteria. This can tell you the rate of customer satisfacti...
How are Medicare plans rated?
The Centers for Medicare and Medicaid Services uses a star rating system to evaluate Medicare Advantage plans and Medicare Part D plans.
Which Medicare plans received 5-star ratings for 2022?
For 2022, there are a total of 87 Medicare contracts nationwide that have a 5-star rating (a significant increase from the 28 Medicare contracts that had 5-star ratings in 2021). Three are Medicare cost plans and 74 are Medicare Advantage plans with integrated Part D coverage.
How has the COVID pandemic affected Medicare star ratings?
Due to the pandemic, the federal government had to contend with the fact that a significant amount of the data used for star ratings could not be collected remotely, and that in-person data collection wasn’t feasible.
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.
Top 5-star Medicare Advantage plans
Medicare Advantage plans with five stars are top-tier plans that are considered "excellent" by the Medicare's administering agency, the Centers for Medicare & Medicaid Services (CMS).
5-star special enrollment period
If a 5-star plan is available in your location, you qualify for a 5-star special enrollment period (SEP) that allows you to switch to a 5-star plan at any time during the year.
How Medicare star ratings are calculated
Each Medicare plan's overall star rating is a weighted average of several different data points. This means it's a robust measurement that can help you understand which are the best-performing Medicare plans in your area.
Frequently asked questions
Medicare star ratings are calculated using 40 criteria across Part C and Part D coverage. This includes survey data about member satisfaction, calculations about the number of complaints, outcomes such as how often those with diabetes fill their prescriptions and more.
Methodology
Data and analysis is based on Centers for Medicare & Medicaid Services (CMS) public use files, fact sheets and technical notes. Medicare Advantage analysis only includes plans that include prescription drug coverage and excludes employer-sponsored plans, special needs plans, PACE plans, sanctioned plans and health care prepayment plans (HCPPs).
What does higher star rating mean?
Higher star ratings mean that a provider has either gone above and beyond the standard or that patient satisfaction is far greater for that provider compared to others.
What does it mean when your Medicare rating is lower?
Instead, a lower rating simply means that there may be better options available.
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.
