Medicare Plan Star Ratings is a five-star rating system created by the Centers for Medicare and Medicaid Services (CMS) so that beneficiaries can compare Medicare Advantage plans and Medicare prescription drug plans, also known as Medicare Part D. Each plan’s performance is evaluated yearly. Plans that are awarded a star rating of four stars or higher receive quality bonus payments from CMS. Basically, the higher the score, the more money that is reinvested into your plan.
Medicare Advantage Star Ratings
Medicare Advantage plans receive their overall star rating from the evaluation of five different categories:
- Staying healthy: access to preventative services to keep members healthy.
- Chronic conditions management: care coordination and frequency of treatment that members received for their long-term/chronic conditions.
- Member experience: overall satisfaction with the plan.
- Member complaints: number of submitted complaints, members who leave the plan, issues receiving services, and plan improvement from one year to the next.
- Customer service: quality of call center services, processing appeals, and new enrollments in a timely manner.
These five categories are the deciding factors that award Medicare Advantage plans with their plan star ratings. Ratings range from 1-5 stars, with 5 being the best plans. When you decide to enroll in a Medicare Advantage plan, you can read and learn about each plan’s star rating to ensure you do not enroll in a plan with a low rating. It is important to receive excellent services in all five of the categories the CMS evaluates Medicare Advantage plans on.
Medicare Part D Star Ratings
Medicare prescription drug plans that are a part of a Medicare Advantage plan, or simply a stand-alone prescription drug plan, are evaluated on four categories, rather than five like Medicare Advantage plans are. Medicare prescription drug plans are evaluated on the following issues:
- Member experience
- Member complaints
- Customer service
- Drug safety and drug pricing accuracy
Drug safety scores are based on multiple factors, such as plan pricing accuracy and how often patients with certain medical conditions are prescribed safer and clinically recommended medications for their ongoing condition.
Medicare prescription drug plans and Medicare Advantage prescription plans are also evaluated on how up-to-date the information posted on their website is. CMS also reviews and considers the number of members who received prescription medications with high-risk side effects.
Whether you seek a stand-alone Medicare Part D plan or plan to enroll in a Medicare Advantage plan that includes a prescription drug plan, you must compare Medicare Plan Star Ratings to ensure you receive the best care most fitting for your needs.
Importance Of Medicare Plan Star Ratings
If you compare Medicare Advantage plans or Medicare prescription drug plans and enroll in one that is four stars or higher, then you are receiving exceptional service via your Medicare plan. It is important to enroll in a plan with a higher star rating for a variety of reasons, such as an improved relationship with your physician, greater focus on health plans to improve care, higher levels of customer service, and providing more focus on preventative services that best benefit you.
For more information about Medicare plan star ratings, give us a call today.