If you’re enrolled in a low-performing plan, CMS
Centers for Medicare and Medicaid Services
The Centers for Medicare & Medicaid Services, previously known as the Health Care Financing Administration, is a federal agency within the United States Department of Health and Human Services that administers the Medicare program and works in partnership with state government…
Medigap
Medigap refers to various private health insurance plans sold to supplement Medicare in the United States. Medigap insurance provides coverage for many of the co-pays and some of the co-insurance related to Medicare-covered hospital, skilled nursing facility, home health care, ambulance, durable medical equipment, and doctor charges. Medigap's name is derived from the notion that it exists to …
What is the best Medicare plan?
Medicare plans eligible for star ratings include Medicare Advantage, Medicare Cost, and Medicare Part D prescription drug plans. Medicare Supplement (Medigap) plans aren’t eligible for …
What is Medicare 5 star rating system?
Fact Sheet - 2022 Part C and D Star Ratings . Note: The information included in this Fact Sheet is based on the 2022 Star Ratings published on the Medicare Plan Finder on October 8, 2021. For details on the Medicare Advantage (MA) and Part D Star Ratings, please refer to the 2022 Part C & D Star Ratings Technical Notes available at
What is a five star Medicare plan?
Jan 31, 2022 · Medicare Part D star ratings include 12 measurements across the five categories, and ratings apply to both standalone Part D plans and the prescription drug benefits included with most Medicare Advantage plans. Accounting for 41% of the overall score, the health outcomes category has the largest impact on overall Medicare Part D star ratings.
Why are Medicare star ratings important?
Medicare Star Ratings were developed to give people more information to consider when choosing a health or prescription drug plan. There are star ratings for Medicare Advantage plans and for Part D Prescription Drug Plans. Generally, plans with …
Which Medicare Advantage plan has the highest rating?
What Does a Five Star Medicare Advantage Plan Mean? Medicare Advantage plans are rated from 1 to 5 stars, with five stars being an “excellent” rating. This means a five-star plan has the highest overall score for how well it offers members access to healthcare and a positive customer service experience.
What determines star ratings Medicare?
A Medicare Advantage plan's overall rating is determined by 5 categories – staying healthy, managing chronic (long-term) conditions, member experience with the health plan, member complaints and changes in the health plan's performance, and health plan customer service.
What is the star rating system for Medicare Advantage plans?
Medicare uses information from member satisfaction surveys, plans, and health care providers to give overall performance star ratings to plans. A plan can get a rating between 1 and 5 stars. A 5-star rating is considered excellent. These ratings help you compare plans based on quality and performance.
What is the Stars program Medicare?
Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Star Ratings are released annually and reflect the experiences of people enrolled in Medicare Advantage and Part D prescription drug plans.Oct 8, 2021
How are star ratings determined?
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 are star ratings based on?
Medicare Advantage plans receive a star rating based on performance measures that are intended to help potential enrollees compare plans available in their area as well as encourage plans to compete based on quality.Jun 21, 2021
What is devoted star rating?
This lets you easily compare plans based on quality and performance. Star Ratings are based on factors that include: • Feedback from members about the plan's service and care. • The number of members who left or stayed with the plan. • The number of complaints Medicare got about the plan.
How many star measures are there?
The 30 measures that will be used to calculate the 2022 Star Ratings for Medicare Advantage plans are below. Several of the values aren't included in the Categorical Adjustment Index, which CMS introduced in 2017 to account for how socioeconomic factors affect Star Ratings. View a full list of the measures here.Jan 21, 2021
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.
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...
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).
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 are the Medicare star ratings?
Medicare uses a system that assigns each plan a star rating from one to five stars. Plans with higher ratings offer higher quality, meaning they offer better care at lower costs through well-known providers and hospitals in their network.
What Medicare Advantage Plans have a 5-star rating?
Like we said, 5-star ratings are very hard to achieve for insurance companies and the Medicare advantage plan they offer. This is done intentionally to keep competition among plans. Sometimes it’s something as medial as not offering transportation coverage that can drag down their 5-star to a 4.5.
What is a 5 star Medicare Advantage Plan?
If a Medicare Advantage Plan, Medicare drug plan, or Medicare Cost Plan with a 5-star rating is available in your area, you can use the 5-star Special Enrollment Period to switch from your current Medicare plan to a Medicare plan with a “5-star” quality rating.
What is a 5 star rating?
Medicare's 5-star rating system gives beneficiaries, as well as the general public, a final grade that represents multiple grading factors. Each type of plan (e.g., Medicare Advantage or Medicare Part D) and each type of provider (e.g., hospital, nursing home, etc.) have different factors that Medicare analyzes to create the final grade.
What is Medicare Advantage?
Medicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medica re Part B).... , including Special Needs Plans ( SNP ), based on how well they performed in the previous year.
Why does CMS use the same grading system?
CMS uses the same type of grading system to measure the performance of its healthcare providers. The benefit of the CMS grading system is that it rolls up many measurements into a single final grade. This final grade allows us, Medicare beneficiaries, to compare health plans at-a-glance. Here’s what each star means:
How many measures are required for Medicare Advantage?
Each year, the insurance companies are required to self-report on each of their contracts. For Medicare Advantage plans that include Part D, there are 45 different measures that get sent to CMS. Each of these measures is rolled up into the nine major categories listed above.
What is the importance of star rating?
IMPORTANT: A plan’s star rating is just one of many factors you should consider when choosing a health plan. Also, take into consideration a plan’s coverage and costs. For instance, if you are considering a Medicare Advantage plan, be sure the plan’s copays.
Do insurance companies have to report self-reports?
Yes. Each year, the insurance companies are required to self-report on each of their contracts. Learn more about what the 5-star ratings on Medicare Advantage and Medicare prescription drug plans mean in this article.
Why do Medicare Advantage plans get stars?
Medicare Advantage plans receive a star rating based on performance measures that are intended to help potential enrollees compare plans available in their area as well as encourage plans to compete based on quality. All plans that are part of a single Medicare Advantage contract are combined when calculating the quality rating ...
How many stars does a health insurance plan have?
As a result of changes made in the Affordable Care Act (ACA), plans that receive at least 4 stars and those without ratings ...
How much is the bonus for Medicare 2021?
UnitedHealthcare and Humana, which together account for 46% of Medicare Advantage enrollment, have bonus payments of $5.3 billion (46% of total bonus payments) in 2021. BCBS affiliates (including Anthem BCBS) and CVS Health each have $1.6 billion in bonus spending, followed by Kaiser Permanente ($1.1 billion), Cigna and Centene ($0.2 billion each).
What percentage of Medicare Advantage plans will receive bonus payments in 2021?
In 2021, 81 percent of all Medicare Advantage enrollees are in plans that receive a bonus payment from Medicare based on star quality ratings (or because they are new), substantially higher than the share in 2015 (55 percent). Annual bonus payments from the federal government to Medicare Advantage insurers have increased correspondingly, ...
How much is Medicare Advantage rebate in 2021?
Additionally, as more enrollees are in plans that are in bonus status, the average rebate per Medicare Advantage enrollee has more than doubled, rising from $184 per year in 2015 to $446 per year in 2021.
Why are bonus payments increasing?
The rise in bonus payments is due to both an increase in the number of plans receiving bonuses, and an increase in the number of enrollees in these plans. Because unrated plans also receive bonus payments, a total of 85 percent of enrollees are in plans that are eligible to receive quality bonus payments, and 81 percent ...
How much is the average bonus for 2021?
The average bonus per enrollee in an employer plan is $886 in 2021, more than 2.5 times higher than for enrollees in either individual plans ($351) or SNPs ($309). While average bonuses in employer plans have consistently been higher than for other plans, the gap has increased substantially in recent years, driven by a rapid rise in the average bonuses for employer plans. Both the high share of enrollees in group plans that receive bonus payments (98% in 2021), as well as changes to the payment methodology for group plans implemented starting in 2017 contribute to this trend.
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.
How are Medicare Plans Rated?
CMS rates Medicare Advantage and Part D plans annually, using a scale from one to five, with more stars equating to better performance and quality. A five-star rating is the highest a Medicare Advantage or Part D plan can receive, and half-ratings also exist (1.5, 2.5, 3.5, 4.5).
Why is the Medicare Star Rating Important?
A Medicare plan’s star rating is important because it can help you when comparing different plans. You should not use a star rating as the only factor when making a final decision though. Some plans that have fewer than five stars may actually be a better fit for you. Use the Medicare star rating as just a single factor of evaluation.
Medicare Made Clear
Medicare Made Clear is brought to you by UnitedHealthcare to help make understanding Medicare easier. Click here to take advantage of more helpful tools and resources from Medicare Made Clear including downloadable worksheets and guides.
Medicare Made Clear
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