Medicare Star Ratings
The Center for Medicare & Medicaid Services (CMS) oversees the administration of Medicare, among other things. CMS created a Five Star Quality Rating System that rates Medicare Advantage (Part C) and Prescription Drug (PDPs or Part D) plans. Ratings are between 1 and 5 stars (5 being the highest) for Medicare plan quality. A plan’s star rating is based on measurements of the customer satisfaction and quality of care the plan delivers.
3 Goals of Medicare Star Ratings
- Improve the quality of care and general health status for Medicare beneficiaries.
- Improve the level of accountability for care provided by physicians, hospitals, and other providers.
- Provide Beneficiaries with a benchmark with which to compare the quality of Medicare plans.
Contact Us to Help You Navigate Your Medicare Options – at no cost and no obligation to you!
Roman Brokers Insurance in Mesa, AZ represents a wide range of Medicare plans and options. We are dedicated to helping you develop a Medicare strategy that best suits your needs and preferences. No one strategy is best for everyone.
Roman Brokers Insurance compares companies and plans for the best possible combinations of quality, cost, coverage and compatibility. A licensed, insured, independent agent will walk you through the process and give a full explanation of the differences between plans. Contact Roman Brokers Insurance today at 480-834-7447. We can provide guidance at no cost and no obligation to you!
How can I find a plan’s star rating?
You can find the star rating for your current Medicare Advantage or Prescription Drug Part D plan by using the Medicare plan finder. If you are just beginning to research your options, you can find a highly rated Medicare plan by contacting Roman Brokers Insurance at 480-834-7447.
How are star ratings developed?
Star ratings are reviewed and updated every year by CMS, with the final quality ratings released in October. CMS conducts a comprehensive review of the measures that make up the star ratings, considering the reliability of the measures, feedback received from stakeholders, and data issues. There are some Medicare plans without ratings because they are new to the marketplace.
Why are star ratings important to my health care?
Cost and coverage of your needed services and drugs are the most important considerations when choosing the Medicare plan you are enrolling in, but star ratings can provide additional points of comparison. Medicare star ratings can assist you in finding a better-plan based on your health care needs and financial situation. If you are enrolled in a Medicare plan that is less than 3 stars it’s considered poor quality and is likely not providing you with the most optimal health care option.
Medicare Advantage plans are given an overall rating based on 5 categories
- Member experience with the health plan – Includes member ratings of the plan.
- Health plan customer service – Includes how well the plan handles member appeals.
- Member complaints and changes in the health plan’s performance – Includes how often Medicare found problems with the plan and how often people had problems with the plan. Includes how much the plan’s performance has improved (if at all) over time.
- Staying healthy – Includes whether people got various screening tests, vaccines, and other check-ups to help them stay healthy.
- Managing chronic conditions – Includes how often people with certain conditions got recommended tests and treatments to help manage their condition.
Medicare Part D plans are given an overall rating based on 4 categories
- Member experience with plan’s drug services – Includes member ratings of the plan.
- Drug plan customer service – Includes how well the plan handles member appeals.
- Member complaints and changes in the drug plan’s performance – Includes how often Medicare found problems with the plan and how often people had problems with the plan. Includes how much the plan’s performance has improved (if at all) over time.
- Drug safety and accuracy of drug pricing – Includes how accurate the plan’s pricing information is and how often people with certain medical conditions are prescribed drugs in a way that is safer and clinically recommended for their condition.
For plans covering both health and drug services (Medicare Advantage Plan with Drug Coverage), the overall rating for quality and performance covers all the topics above.
5-star plan Special Enrollment Period (SEP)
If one is available in your area, you have the freedom to switch to a plan that has 5 stars for its overall star rating from December 8 to November 30, but you can only use this SEP once during this timeframe. Additionally, you can only switch to a 5-star Medicare Prescription Drug Plan if one is available in your area.
Special Enrollment Period to dis-enroll from lower-rated plans
If a plan receives a rating from CMS lower than 3 stars for 3 straight years, it is considered a low-performing plan. If you are enrolled in one of these, you get a one-time SEP from January 1 to December 31 to enroll in a plan that is rated 3-stars or better or a plan with no rating (since there are some plans that are too new to rate).
It is possible that a 5-star Medicare Advantage Plan may not include drug coverage. For both SEPs, if you move from a Medicare Advantage Plan that has drug coverage to a 5-star Medicare Advantage Plan that doesn’t, you may lose your prescription drug coverage. Since the SEP can only be used once, you may have to wait until the next AEP to get drug coverage. Doing so may result in a lifetime late enrollment penalty.
Contact Us to Help You Navigate Your Medicare Options
So many choices, and so many considerations! Roman Brokers Insurance in Mesa, AZ represents a wide range of Medicare plans and options. We are dedicated to helping you develop a Medicare strategy that is easy to understand and best suits your needs and preferences. No one strategy is best for everyone.
Roman Brokers Insurance compares companies and plans for the best possible combinations of quality, cost, coverage and compatibility. A licensed, insured, independent agent will walk you through the process and give a full, unbiased, accurate explanation of each plan option and when you can enroll. Contact Roman Brokers Insurance today at 480-834-7447. We can provide guidance at no cost and no obligation to you!