What is a Medicare star rating?
The Centers for Medicare Services (CMS) developed the star rating system to rate out both Medicare Advantage plans and Prescription Drug plans. The ratings are determined by the quality of each plan as well as the level of customer satisfaction on an annual basis. The ratings are given on a scale of one to five stars, with five stars being the highest rated plans. The rating system helps improve the quality on plans and also allows Medicare to track the quality of care given to beneficiaries by both the plan as well as the providers.
The five categories that determine ratings:
1. Experience of Plan Members
This is the member feedback portion of the rating, and how the member feels that they are treated by plan participating providers as well as how easily they feel they are able to fill their prescriptions.
2. Member Health
Member health is measured by their access and use of plan preventative services such as screenings, physicals and vaccinations. This category will tell you how well a plan pushes preventative services and member health through the use of incentives.
3. Chronic Condition Management
This portion of the star rating determination monitors how the particular plan provides recommended treatments for chronic long-term health problems the member may have. Each plan offers programs and resources to help manage the health of their members who may be experiencing a chronic condition like diabetes or arthritis.
4. Customer Service
How satisfied are you with the plan and carrier's problem resolution? Customer service also includes how appeals, claims, and new enrollments are processed.
5. Complaints & Plan Performance
Complaints and problems members face are also tracked within the star rating system. This category also tracks how the plan resolves these problems and makes adjustments to the plan to make members happier.
Prescription Drug Plan Ratings
Medicare's prescription drug ratings are also determined by the five categories listed above, but they also take drug safety and drug pricing accuracy into account when rating out these types of plans.
5-Star Plans
Very few plans get the five star rating by CMS, so these plans are viewed as excellent options for many Medicare eligible folks. CMS enables beneficiaries to enroll in a five star plan at any point throughout the year as a 'special election'. A plan with four stars is also seen as above average and a good option for individuals as well. On the opposite end, if CMS gives a plan a star rating less than three stars for three straight years it is viewed as a low performing plan and CMS will reach out to individuals advising them to seek alternative plan options in their area.
Conclusion:
CMS gives out plan star ratings every October. It is important to consider the star rating when evaluating plans throughout AEP. It offers a glimpse of what the beneficiary can expect from the plan and how satisfied they could potentially be with the particular plan.
