What are Medicare star ratings and why are they important?
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
When did the ACA star rating system start?
In September of 2021, CMS announced the Medicare Star Ratings for the 2022 plan year. At Humana, we’re proud to say that 97% of our Medicare Advantage and Medicare prescription drug plan (PDP) members are enrolled in plans rated 4 out of 5 stars or higher for 2022. 3 You may be able to switch to a 5-star plan
What categories are measured in the star rating system?
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 …
What are the ratings for Medicare Advantage plans?
Jan 31, 2022 · Medicare Star-Rating System: A method for evaluating and ranking nursing homes used by the U.S. Centers for Medicare and Medicaid Services (CMS). The Medicare star-rating system is intended to ...
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 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 .
How often can you use a SEP?
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. The SEP begins Dec. 8 of the year before the plan is considered a five-star plan (ratings comes out in October). It lasts through Nov. 30 of the year the plan is deemed a five-star plan.
Who is James Chen?
Medicare Star-Rating System. James Chen, CMT, is the former director of investing and trading content at Investopedia. He is an expert trader, investment adviser, and global market strategist.
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.
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.
When was the National Quality Forum released?
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.
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]
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.
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.
