What Do Those Medicare Star Ratings Mean?

If you’ve ever gotten a quote for Medicare Advantage or Part D Prescription Drug plans, you might have noticed that each plan was rated on a 1 to 5-star scale. What do those ratings mean and where do they come from?

First of all, the star ratings come from the Center for Medicare and Medicaid Services (CMS), not from the plan beneficiaries themselves. So a plan’s star rating is not solely an indication of how satisfied its members are, although that is a major factor. In fact, there are 53 total topics on which plans can be rated. Here is a summary of those factors, categorized by plan type:  

Medicare Advantage Plans (no prescription coverage)

For plans that include health coverage only and no prescription drug coverage, the overall quality score is based on 36 different topics in 5 categories:

• Staying healthy: screenings, tests, vaccines
• Managing chronic conditions
• Member ratings of health plan responsiveness and care
• Member complaints
• Customer service

Part D Prescription Drug Plans (no health coverage)

For plans that include prescription drug coverage only and no health coverage, the overall quality score is based on 17 different topics in 4 categories:

• Customer service
• Member complaints
• Member experience with plan’s drug services
• Drug pricing and patient safety

Medicare Advantage + Part D Plans (both health and prescription coverage)

For plans that include health coverage and prescription drug coverage, the overall quality score is based on all 53 topics.

5 Stars = Excellent

4 Stars = Very Good

3 Stars = Average

2 Stars = Fair

1 Star = Poor

The average star rating for Medicare Advantage and Part D plans is 3.27, but 91% of plans receive a rating of 3 stars or more.

Why are these star ratings important?

The star quality ratings give you a way to quickly and easily compare plans based on factors like quality and performance—not just financial considerations like premium, benefits and network. These ratings are also important because CMS has created a Special Election Period (SEP) that allows Medicare beneficiaries to enroll in 5-star Medicare Advantage plans at any point during the year.

Starting in 2012, the star ratings took on increased significance for the insurance companies as well. As of this year, carriers can receive bonus payments from the government based on their quality ratings. With this incentive, you can expect increased focus from the insurance companies on increasing their performance in disease management, preventive care, and customer service.

Mature Health Center incorporates these star ratings in our Medicare Advantage and Part D quoting tools.  Visit www.MedicareInsuranceDirect.com to get a quote today!