Full Answer
What does the Medicare star rating mean?
The Medicare star rating is designed as a way to help consumers select a Medicare Advantage plan as well as evaluate how well plans that contract with Medicare perform. Medicare assigns a star rating from 1 to 5, with 5 being the best, for both Medicare Advantage and Medicare Part D (prescription drug coverage) plans.
What percentage of Medicare Advantage plans have 4 or more stars?
Approximately 90 percent of people currently in Medicare Advantage plans that offer prescription drug coverage are enrolled in a plan that earned four or more stars in 2022. The number of plans with a rating of 4 or more stars is higher for 2022 compared to last year.
What categories are measured in the star rating system?
What categories are measured in the star rating system? Medicare Advantage plans are ranked by five criteria: performance with preventative care such as screenings and vaccines, managing chronic conditions, plan responsiveness and care, member complaints and number of times people leave the plan, and the health plan’s customer service.
How do I know if my Medicare plan is 5-star?
When you are comparing plans on the Medicare.gov website or talking to a licensed insurance agent, all star rankings are clearly identified and 5-star plans are indicated by a special icon—a gold triangle with the number 5 inside.
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.
What is a star rating?
Medicare Star Ratings are an important measurement of a health or prescription drug plan's overall quality. Each year, the Centers for Medicare and Medicaid Services (CMS) gives an overall rating on how well Medicare plans perform in 6 categories.
What Does stars mean in healthcare?
National distribution of the Overall Hospital Quality Star RatingOverall ratingNumber of hospitals (N=4,586, %)1 star204 (6.06%)2 stars690 (20.57%)3 stars1,018 (30.34%)4 stars988 (29.45%)2 more rows
What are star ratings important to Medicare Advantage plans?
The Star Ratings system rewards higher-performing plans. This means that those with four or more stars receive annual bonus payments from the CMS. The higher the rating, the higher the bonus.
Is 3 stars a good rating?
Three stars meant 'excellent,' two 'good,' and one star meant 'mediocre. ' And no stars at all 'means the picture's right bad,'" wrote Thirer. Carl Bialik speculates that this may have been the first time a film critic used a star-rating system to grade movies.
How is Medicare star rating calculated?
Understanding Z-scoring For the Overall Star Rating, Z-scores were produced by subtracting the national mean score from each hospital's measure score and dividing that by the standard deviation across hospitals. Standard deviation is a number that measures how far data values are from their average.
What are the Medicare Stars?
The Medicare STARS program determines how well plans and providers perform across a section of quality measures using information from member satisfaction (both plan and providers), health outcomes and plan operations. A plan can get a rating from one to five stars. A 5-STAR rating is considered excellent.
What is the highest rated Medicare Advantage plan?
List of Medicare Advantage plansCategoryCompanyRatingBest overallKaiser Permanente5.0Most popularAARP/UnitedHealthcare4.2Largest networkBlue Cross Blue Shield4.1Hassle-free prescriptionsHumana4.01 more row•Jun 22, 2022
What are Medicare Part D star ratings?
Medicare Part D Star Ratings The Centers for Medicare & Medicaid Services (CMS) creates plan ratings that indicate the quality of Medicare plans on a scale of 1 to 5 stars with 5 stars being the highest rating.
What is the best Medicare Part D plan for 2022?
The 5 Best Medicare Part D Providers for 2022Best in Ease of Use: Humana.Best in Broad Information: Blue Cross Blue Shield.Best for Simplicity: Aetna.Best in Number of Medications Covered: Cigna.Best in Education: AARP.
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.
How many stars are there in Medicare Advantage?
The categories are ranked between one to five stars, with five being the highest and one being the lowest. According to Medicare Interactive, Medicare Advantage Plans are rated on their performance in the following five different categories: 1 .
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.
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 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 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.
What are the problems with the Star Rating System?
The Star Rating System has had other unintended consequences resulting from poor program structure and misaligned incentives. Some of the biggest problems with the program structure relate to timing. The measurements that will be evaluated each year are determined and announced after both the period from when the measurements are taken and after contract submissions for the following year are due. This leaves plans unaware of what they’re being evaluated on, which makes it difficult to know what they should be doing or to make appropriate changes for the next year resulting in a two-year lag on adjustments by plans and their providers, at best. Another concern is that the retrofitting of the evaluation criteria could allow for CMS to pick winners and losers by selecting criteria that specific companies perform particularly well (or poor) on. Further, the bonus payments are based on the benchmark price and enrollment in the following year from when the measures were taken, which means plans are rewarded for patients they weren’t necessarily covering at the time the reward was earned. Finally, not making the evaluation criteria known ahead of time and delaying the reward is inconsistent with all theories on how to make reward incentive programs effective.
Why is the Star Rating System unfair?
Many have expressed concern that the Star Rating System—because of how measures are evaluated and rewards are paid —unfairly punishes both low-income enrollees and the plan sponsors primarily serving such enrollees. It is argued that a significant portion of the measures evaluated are influenced by a patient’s socioeconomic conditions, yet very few of the measures are risk-adjusted to neutralize the impact of such differences between patients, thus not allowing for a fair comparison between plans with high versus low enrollment of low-income individuals. This concern has led to calls for either establishing a separate rating system for Special Needs Plans (SNPs) or any MA plan in which enrollees are predominantly low-income, or providing a score adjustment for such plans in order to compensate for those patient differences. [19] The National Quality Forum, in its report released in August 2014, notes the well-documented link between patients’ sociodemographic conditions and health outcomes, and recommends that such factors be included in risk adjustments for performance scores. [20]
What is a reward plan?
Rewards are two-part: direct bonus payments to the plan operator and rebates which must be returned to the beneficiary in the form of additional or enhanced benefits , such as reduced premiums or co-payments, expanded coverage, etc.
What is MAO rating?
Ratings are set at the MAO contract level—not the plan level—meaning all plans under the same contract receive the same score. Stars are assigned to each contract for each individual measure being evaluated, based on relative performance compared to the other contracts. The overall summary score for each contract is then calculated by averaging ...
Why are all plans not able to achieve top ratings?
All plans will not be able to achieve top ratings, however, because the system uses relative scoring, essentially ranking plans in order of achievement— not everyone can be the best.
How many MA contracts received bonus payments in 2012?
In 2012, 91 percent of MA contracts received a bonus payment, but only 4 percent of the total bonus payments came from funds designated for these bonuses by the ACA—the rest of the bonuses were paid through the demonstration project which allowed for bonuses to be paid to 3-star plans. [12] Two thirds of total payments went to plans with less than 4-star ratings. [13]
Does MA Stars pay for performance?
The MA Stars system is not a typical pay for performance program. Since CMS does not directly pay care providers in MA, but rather pays insurers offering private coverage to Medicare beneficiaries, the reward is actually being paid to an intermediary in the provision of care.
How does Medicare Advantage affect its star rating?
So, a Medicare Advantage plan’s star rating affects its revenues, its ability to attract new members, and its marketing activities. That’s why one publication has written, “Health plans … are investing in processes to maintain or improve their star standing.”. [vi]
How many stars are there for Medicare Advantage?
Each year, every Medicare Advantage plan (Part D) is rated [iii] on a scale of 1 to 5 stars based on how well the plan performed in the following areas: Helping members stay healthy. Managing chronic conditions.
Why do star ratings matter?
Star ratings matter a great deal to Medicare Advantage (MA) plans because these ratings affect their revenue, reimbursements and enrollment. [i] Since many of your customers are enrolled in MA and MA Prescription Drug Plans (MAPDPs) and because the care you provide as community ...
How does MA plan rating affect compensation?
Top-performing plans (those that achieve at least 4 stars) can receive bonus payments, which can boost revenue and affect a plan’s bottom line. Consumers are more likely to select well-rated plans.
Can patients enroll in low performing plans?
Patients can’t enroll in low-performing plans. Currently, the Medicare Finder Plan blocks consumers’ ability to enroll in plans with the Low Performer Icon — those with less than 3 stars for at least three years in a row. Beginning in 2015, CME has the authority to terminate low-performing plans. [v]
Do consumers choose well rated plans?
Consumers are more likely to select well-rated plans. A study in the Journal of the American Medical Association [iv] found that if a plan was rated one star higher than another, first-time beneficiaries were 10% more likely to enroll in the higher-rated plan, and beneficiaries switching plans were also more likely to enroll in higher-rated plans. ...
Do pharmacies get star ratings?
While pharmacies don’t directly receive star ratings , you’re a critical member of the team that drives quality healthcare. To achieve high star ratings, Medicare Advantage health plans increasingly want to work with providers who understand and support their objectives — including achieving high star ratings — and who can provide services and experiences that help boost these ratings. Some retail chains see and have jumped on this opportunity to collaborate with MA plans to improve their star ratings. [ix] Community pharmacies have the same opportunity to work collaboratively with plans in their area to deliver strong ratings.
