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Medicare SSBCI vs. VBID: What’s the Difference

Two major innovations in the Medicare Advantage (MA) program; special supplemental benefits for the chronically Ill (SSBCI) and the Value-Based Insurance Design (VBID) Model, both aim to improve outcomes for beneficiaries with chronic conditions. However, they differ in purpose, eligibility, benefits, and future outlook. Here’s what you should know about Medicare SSBCI vs VBID and how they compare.

What Is SSBCI

The Special Supplemental Benefits for the Chronically Ill (SSBCI) program was created under the Bipartisan Budget Act of 2018. It allows Medicare Advantage plans to offer non-traditional, non-medical benefits designed to help people with serious chronic illnesses maintain or improve their health and daily function.

To qualify, a beneficiary must:

1. Have one or more complex chronic conditions,
2. Be at high risk of hospitalization or other negative outcomes, and
3. Require intensive care coordination.

Unlike standard Medicare benefits, SSBCI may cover services such as healthy groceries, home air-quality equipment, pest control, transportation, or home modifications. These benefits address social factors that affect health, such as nutrition, housing, and access to care.

Watch a YouTube video on the prescription payment program

SSBCI benefits are optional, meaning not every MA plan offers them. Plans also decide what types of benefits to include and who qualifies. CMS is increasing oversight to ensure these benefits are supported by evidence showing they can improve or maintain a member’s health or function.

SSBCI represents a shift in Medicare Advantage toward whole-person care; addressing more than just medical needs.

What Is VBID?

The Value-Based Insurance Design (VBID) Model, launched by the CMS Innovation Center, allowed participating Medicare Advantage plans to align cost-sharing and benefits with the clinical value of care. The goal was to lower barriers to high-value care (like preventive services or chronic disease management) while discouraging unnecessary spending.

VBID gave participating plans flexibility to reduce copays, expand supplemental benefits, and even test hospice care integration within MA. These features often targeted individuals with chronic illnesses, low income, or those living in underserved areas.

However, VBID was a demonstration model, not a permanent part of Medicare. In 2025, CMS announced it will end the VBID Model after determining that program costs to Medicare were higher than anticipated. While the model is ending, many of its design ideas; like targeted cost-sharing and flexible benefits, are expected to influence future MA benefit structures.

SSBCI vs. VBID: A Quick Comparison

Why It Matters

Both programs reflect a growing focus on integrated, person-centered care in Medicare Advantage.

• For beneficiaries: SSBCI can provide meaningful extra help for daily living and health support, but eligibility rules apply. Not everyone in an MA plan will qualify.
• For VBID participants: The model’s end may change how some plan benefits are structured in 2026, but many innovations are expected to remain.
• For all MA enrollees: When comparing plans, look beyond premiums and copays. Review whether a plan offers SSBCI or other supplemental benefits that fit your personal needs.

Always review your plan’s Summary of Benefits and Evidence of Coverage to see if SSBCI options are available, and confirm your eligibility with the plan.

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SSBCI and VBID have both pushed Medicare Advantage toward smarter, more holistic care. While VBID will conclude in 2025, SSBCI continues to grow; helping address many factors that shape health outcomes. Together, they represent Medicare’s evolving goal: not just to pay for medical care, but to help beneficiaries live healthier, more independent lives.

Humana Medicare 2026 OTC Benefits: How to Use and Access Them

Many Humana Medicare Advantage (Part C) plans include an over-the-counter (OTC) allowance to help members save on everyday health items. Fortunately, Humana Medicare 2026 OTC benefits provides members more ways to maintain their health while managing out-of-pocket costs.

What the OTC Benefit Covers

Humana’s OTC benefit allows members to buy non-prescription health and wellness products at no cost, up to a set allowance. Covered items typically include:

• Pain relievers and cold medicines
• Vitamins and supplements
• Dental care items like toothbrushes and toothpaste
• First-aid and wound-care supplies
• Digestive aids and bladder-control products

Depending on the plan, members may receive a monthly or quarterly allowance to spend. Some plans offer rollover options, while others require that unused funds be used within the benefit period.

Watch a YouTube video on Medicare Advantage vs Medicare Supplements

How to Access Your OTC Benefit

1. Confirm Eligibility – Log into your MyHumana account or review your Summary of Benefits to confirm your plan includes an OTC allowance. You can also call the Member Services number on your Humana ID card.
2. Know Your Allowance – Find out how much you receive and how often it renews. Available benefits vary by plan and region.
3. Shop for Eligible Items – You can use your OTC funds in several ways:
   • Humana Spending Account Card – Many plans load your allowance onto a prepaid card you can use at participating retailers.
   • Mail Order or Online Catalog – Some plans require ordering through CenterWell Pharmacy’s OTC catalog or online store.
4. Use It Before It Expires – Most allowances expire at the end of each benefit period or at year-end. Check your balance often to avoid losing unused funds.

Tips to Maximize the Benefit

• Review Plan Changes Annually: OTC benefits and amounts can change each year. Always read your Annual Notice of Change (ANOC) each fall.
• Shop Early and Smart: If mail order is required, place orders early to allow for shipping time.
• Combine Benefits: Some Humana plans that include Healthy Options or grocery allowances encourage clients to take advantage of all available extras.
• Keep Receipts: If questions arise, documentation helps confirm eligible purchases.
• Ask for Help: Members can contact Humana Member Services or their licensed agent for guidance.

Why This Benefit Matters

Humana’s OTC benefit helps reduce the cost of everyday health items, adding value to Medicare Advantage coverage. For 2026, these allowances highlight Humana’s focus on affordability and wellness. When clients understand and use these benefits fully, they save money, improve their health, and feel more satisfied with their plan.

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Protecting Medicare Consumers And Agents

Across the country, both Medicare and Affordable Care Act (ACA) consumers and the independent agents who serve them are facing new challenges. Many insurance carriers are reducing or eliminating commissions, restricting access to plan applications, or changing payment structures. These practices can disrupt fair competition and limit the ability of agents to provide clear, unbiased help to beneficiaries. Ther have been many people wondering; who is protecting Medicare consumers and agents amidst all this change.

To address this growing concern, NABIP has stepped forward as a strong advocate for both consumers and agents. On October 21, 2025, NABIP sent a letter to the National Association of Insurance Commissioners (NAIC) and all state insurance commissioners, urging a coordinated response to protect fairness in the Medicare and ACA markets.

NABIP’s concerns include:

• The use of “zero-commission” or drastically reduced commission structures on select plans
• Limiting or removing access to plan applications for appointed agents
• Making mid-year commission changes without proper notice
• Steering consumers toward carrier-preferred products by discouraging certain plan sales.

According to NABIP, these tactics not only manipulate markets but also restrict consumer choice and weaken the role of licensed, independent agents. Agents are essential to helping seniors and individuals with disabilities navigate complex coverage options and make informed decisions.

Watch a YouTube video on Medicare Advantge plans going non-commissionable

NABIP referenced the Idaho Department of Insurance as a model for other states

Idaho’s Bulletin No. 25-06 clarified that carriers must keep plan applications accessible to both agents and consumers, prohibit mid-year commission changes, and ensure commissions included in filed products are paid as approved. NABIP is urging every state to adopt similar protections to maintain fairness and transparency.

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Independent agents are a cornerstone of consumer protection. They act as trusted advisors who focus on client needs; not corporate preferences. When compensation is reduced or access is restricted, consumers lose guidance, choice, and confidence in the system.

NABIP continues to work with regulators nationwide, offering documentation, examples, and testimony from licensed producers. Its goal is clear: to ensure accountability, preserve competitive markets, and protect the vital connection between consumers and the professionals who serve them.

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Understanding Coordinated Care: How It Improves Health

When it comes to your health, it’s not uncommon to see several doctors, specialists, or therapists over time. But have you ever wondered who’s making sure everyone is on the same page about your care? That’s where understanding coordinated care comes in. This is an approach designed to keep healthcare connected, organized, and focused on the patient as a whole.

What Is Coordinated Care

Coordinated care is a healthcare model that ensures all members of the care team; from primary care providers to specialists, hospitals, and even pharmacists, work together to manage overall health. The goal is simple: to deliver high-quality care that meets healthcare needs while reducing confusion, delays, and unnecessary costs.

Instead of treating each health concern in separately, coordinated care looks at your entire health picture. It’s a team-based, patient-centered approach that emphasizes communication and collaboration across all your healthcare providers.

Watch a YouTube video on the Discontinued Medicare Advantage Plan Special Enrollment Period

How Coordinated Care Works

In a coordinated care system, one provider (often your primary care physician or a dedicated care manager) takes the lead in managing your treatment plan. This person acts as your main point of contact and ensures that:

• Providers share test results and medical records to forma treatment plan
• Treatments don’t overlap or conflict
• You understand your medications and next steps
• Your transition between care settings; such as from hospital to home, goes smoothly

This kind of teamwork helps prevent medical errors, unnecessary repeat tests, and medication mix-ups that can happen when care is fragmented.

Examples

• A person living with diabetes might see a primary care doctor, an endocrinologist, and a nutritionist. In coordinated care, these professionals communicate regularly to align medications, diet recommendations, and follow-up visits.
• After a hospital discharge, a care coordinator might help schedule follow-up appointments, review discharge instructions, and ensure the patient fills their prescriptions; reducing the chance of readmission.
• Many Medicare Advantage and Accountable Care Organizations (ACOs) use coordinated care models to deliver more efficient and effective care for members.

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Why Coordinated Care Matters

Coordinated care isn’t just about organization; it’s about better outcomes. When providers share information and work together, you benefit from:

• Improved overall health
• Fewer hospital visits
• Lower out-of-pocket costs
• Greater satisfaction with your care

Most importantly, it ensures that care reflects your personal goals, preferences, and lifestyle because no one’s health journey looks the same.

Coordinated care is about putting the patient back at the center of the healthcare experience. By connecting the dots between your doctors, specialists, and support services, coordinated care leads to smarter, safer, and more compassionate healthcare.

Whether you’re managing a chronic condition or just want a smoother healthcare experience, coordinated care helps ensure that every part of your health story fits together the way it should.

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Medicare Drug Cost Cap 2026

Beginning in 2025, Medicare introduced one of the most significant changes to prescription coverage in years: a yearly limit on out-of-pocket costs for medications under Medicare Part D. This change continues in 2026, with a slightly higher limit on the Medicare drug cap 2026 designed to help beneficiaries manage rising prescription expenses.

What Is the 2026 Medicare Drug Cap?

In 2026, the Medicare Part D out-of-pocket cap will be $2,100. Once a beneficiary pays $2,100 in out-of-pocket costs for covered prescription drugs in a calendar year, they will owe nothing more for those medications for the rest of the year.

This cap includes deductibles, copays, and coinsurance for covered Part D drugs, but it does not include:

• Monthly Part D premiums
• The cost of drugs covered under Medicare Part B (such as infusions administered in a doctor’s office)
• Medications not on the plan’s formulary

Whether someone has a stand-alone Part D plan or a Medicare Advantage plan with drug coverage, the cap applies to all covered prescriptions.

Why This Change Matters

Before this new system, Medicare beneficiaries had no upper limit on out-of-pocket drug costs. This meant that those with chronic illnesses or expensive specialty medications could spend thousands each year with no relief.

The new $2,100 cap gives beneficiaries greater financial protection and predictability. Once the limit is reached, cost-sharing ends, offering peace of mind for those managing ongoing or high-cost prescriptions.

The increase from $2,000 in 2025 to $2,100 in 2026 accounts for inflation and rising drug prices. This cap is part of the Inflation Reduction Act (IRA), which aims to make medications more affordable and includes additional measures like insulin cost caps and Medicare drug price negotiations.

How the Cap Works

Here’s an example:
Suppose Mary, a Medicare beneficiary, pays copays and coinsurance for her medications throughout 2026. Once her total out-of-pocket spending for covered Part D prescriptions reaches $2,100, she won’t have to pay anything else for those drugs for the rest of the year.

However, it’s important to note that costs for non-covered or Part B drugs won’t count toward the cap. Also, her monthly plan premiums remain separate and will continue.

Watch a YouTube video explaining the drug cap

What Beneficiaries Should Do

Even with this welcome protection, it’s crucial to review your plan each year during the Medicare Annual Enrollment Period (October 15 – December 7). Here’s what to consider:

• Check your plan’s formulary: Make sure all your prescriptions are covered.
• Compare plan costs: Premiums, deductibles, and copays can vary widely between plans.
• Track your spending: Plans will monitor your progress toward the cap, but keeping your own records is wise.
• Explore payment options: The new Medicare Prescription Payment Plan allows beneficiaries to spread out their drug expenses evenly throughout the year instead of paying large costs upfront.

A Step Toward Affordability

The 2026 Medicare drug cost cap is a milestone for millions of Americans who depend on prescription medications. While it doesn’t eliminate all costs, it offers much-needed relief and certainty for those facing high drug expenses.

By understanding how the cap works and reviewing coverage carefully, Medicare beneficiaries can make informed decisions and take full advantage of this new protection.

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Wellcare Spendables Card 2026

The Wellcare Spendables Card continues to be a popular feature of many Wellcare Medicare Advantage (MA) and Dual Eligible Special Needs (D-SNP) plans. The Wellcare Spendables Card 2026 has expanded how and where members can use the card, making it even more valuable for managing everyday health expenses.

What Is the Spendables Card

The Spendables Card is a preloaded debit-style card given to eligible Wellcare members. It includes a monthly or quarterly allowance that can be used for approved health-related purchases. Depending on your plan, the card can pay for:

• Over-the-counter (OTC) health items like pain relievers, cold medicine, or vitamins
• Dental, vision, and hearing costs such as exams, eyeglasses, or dentures
• Healthy groceries and nutritional drinks
• Home safety items like grab bars or bathroom supports
• In some plans, gas, rent, or utility assistance for qualifying members

The allowance amount and eligible categories vary by plan and state, so it’s important to review your plan’s 2026 Summary of Benefits.

What’s New for 2026

1. Expanded coverage: More plans now let members use their Spendables balance on dental, vision, and hearing expenses, not just OTC items.

2. Broader retail network: Members can use their cards at more than 66,000 national retailers, including major pharmacies and grocery stores.

3. Integrated rewards platform: The Spendables Card now connects with the Wellcare Rewards program, so eligible members can manage both benefits through one system.

4. Added flexibility for chronic conditions: Members qualifying under Special Supplemental Benefits for the Chronically Ill (SSBCI) may use their allowance for gas, home safety, rent, pest control, or utility assistance.

Watch a YouTube video about the drug cap

How to Use the Card

After activation (via the member portal, app, or phone), you can use the card like a debit card at approved stores or providers. Common uses include:

• In-store or online OTC purchases at participating retailers
• Paying providers directly for covered dental, vision, or hearing costs
• Purchasing groceries or home items if your plan allows healthy food or safety benefits

If your total purchase exceeds your allowance, you’ll need to pay the difference. Unused balances may roll over month to month but generally expire at year’s end.

Why It Matters

The Spendables Card helps reduce out-of-pocket costs for everyday health needs while giving members flexibility and convenience. It also supports social determinants of health, recognizing that access to food, transportation, and home safety are vital to well-being. For dual-eligible and chronically ill members, the expanded benefits can provide meaningful support beyond medical care.

Key Questions to Ask

Before using your card, confirm:

• How much is my monthly or quarterly allowance?
• What items and services are eligible under my plan?
• Does my plan include healthy food, utilities, or rent benefits?
• Will unused funds roll over?
• Which stores and providers accept the card?

Example in Action

Mary, a Wellcare D-SNP member, receives a $100 monthly allowance. She buys OTC cold medicine and uses the remaining balance toward her dental copay. The next month, she uses part of the card to purchase fresh produce from an approved grocery retailer. Any leftover funds roll into the following month, helping her stretch her allowance through the year.

Final Thoughts

The Wellcare Spendables Card is a strategic benefit that can help Medicare Advantage and D-SNP beneficiaries pay for a wider range of health-supporting purchases in 2026. Going beyond traditional medical care, it reflects a broader view of wellness and takes into account social needs like home safety, food, housing and utilities (for eligible members).

If you or someone you’re helping is enrolling in a Wellcare plan for 2026 or already a member, it’s well worth taking the time to understand exactly how the Spendables card works under their specific plan, what the dollar amount is, what it covers, how to use it; and make a plan to use its allowance wisely.

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Medicare as Primary Insurance

When you turn 65 or qualify for Medicare due to disability, one of the most important things to know is whether Medicare becomes your primary or secondary insurance. Understanding Medicare as primary insurance helps avoid billing issues and unexpected out-of-pocket costs.

What Does “Primary” Mean

The primary payer is the insurance that pays your medical bills first. The secondary payer may cover costs that the primary insurance doesn’t pay; such as deductibles, coinsurance, or copays.
When Medicare is your primary insurance, your healthcare providers bill Medicare first. Once Medicare pays its share, any remaining balance may be sent to your secondary insurance, such as an employer plan or Medigap policy.

When Medicare Is Primary

Medicare typically pays first in these situations:

1. You’re retired and not covered by active employer insurance.
   Once you stop working and lose active coverage from an employer, Medicare becomes your primary insurance.
2. You have a small employer plan (fewer than 20 employees).
   If you’re still working or covered under a spouse’s small employer plan, Medicare pays first.
3. You have retiree coverage.
   Retiree insurance or COBRA coverage always pays after Medicare.
4. You have no other insurance.
   If Medicare is your only health coverage, it’s automatically primary.
5. You’re covered by Medicaid.
   Medicaid is always the payer of last resort, so Medicare pays first.

Learn about Medicare and employer coverage

When Medicare Is Secondary

In some cases, Medicare may pay after another insurance plan:

• You or your spouse are actively working for an employer with 20 or more employees, and you’re covered under that employer’s health plan.
• You’re receiving workers’ compensation or have a claim covered under no-fault or liability insurance.
• You’re under age 65 and have employer coverage due to disability, and the employer has 100 or more employees.

In these situations, your employer or other insurance must pay first, and Medicare acts as a secondary payer.

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Why It Matters

Knowing when Medicare is primary ensures your medical claims are processed correctly. If you enroll in Medicare but fail to tell your other insurer, or vice versa, you could face denied claims or late enrollment penalties.
Always confirm your coverage status with both Medicare and your employer’s benefits administrator to avoid costly mistakes.

Medicare’s role; whether it’s primary or secondary, depends on your work status, the size of your employer, and any additional coverage you may have.
If you’re nearing retirement or changing jobs, take time to review how your coverage coordinates. Doing so helps ensure smooth billing and gives you peace of mind knowing your healthcare costs are properly covered.

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Understanding Medicare Formulary Exceptions — And How to Get One

When you’re enrolled in a Medicare Part D or Medicare Advantage plan with prescription drug coverage, your plan covers medications according to the plan’s formulary; the list of drugs the plan agrees to cover. What happens if the prescribed medication isn’t on that list, or it’s coverage has restrictions? That’s when understanding Medicare formulary exceptions becomes very important.

A formulary exception is a special request made by a plan enrollee with supporting information from their doctor or directly from their doctor for a plan to cover a drug that’s not included in the plan’s formulary, or to waive certain restrictions, like prior authorization or step therapy.

When You Might Need a Formulary Exception

You might need to request an exception if:

• Your medication isn’t on your plan’s formulary.
• Your plan requires step therapy, meaning you must first try a different (and usually less expensive) drug before the one your doctor prescribed.
• There’s a quantity limit, and your doctor believes you need more than what’s allowed.
• Your plan makes a formulary change mid-year, and the drug you rely on is no longer covered.

If your doctor determines that no covered drug will work as well for your condition, or that other alternatives could cause adverse effects, you can request an exception.

Watch a YouTube video that explains the Drug Cap

How to Request a Formulary Exception

Here’s the process step-by-step:

1. Talk to your doctor first. Your prescribing doctor must support your exception request and provide medical justification explaining why the specific drug is necessary.
2. Submit the request form. You (or your doctor) will complete your plan’s Coverage Determination Form. Most plans provide this form online or through their customer service department.
3. Wait for the plan’s decision.
   • The plan must make a decision within 72 hours for standard requests.
   • If your doctor believes you need the medication sooner due to your health, you can ask for an expedited (fast-track) review, which requires a decision within 24 hours.
4. If denied, you can appeal. You have the right to appeal the decision through multiple levels if necessary. Your doctor can help provide additional medical documentation to strengthen your case.

Tips for a Successful Exception Request

• Provide clear medical justification. The more detailed your doctor’s explanation, the better.
• Submit supporting evidence. Include prior medical history, records of failed alternative treatments, or side effect reports.
• Act early. If you know your plan doesn’t cover a medication, start the exception process before you run out of your current supply.

Formulary exceptions can seem complicated, but they exist to ensure you have access to the medications you truly need. Working closely with your doctor and following your plan’s process carefully can make all the difference.

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If you’re unsure how to begin, contact your plan’s member services department; they can walk you through the steps and provide the necessary forms. Being proactive can help you avoid treatment interruptions and unnecessary stress.

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Medicare Agents as TPMOs: Compliance and Best Practices for Medicare Agents

As a Medicare agent, you are more than just a licensed professional helping beneficiaries find the right coverage; you are officially recognized by CMS as a Third-Party Marketing Organization (TPMO). Understanding Medicare agents as TPMOs is crucial to protecting your business and staying compliant.

What Is a TPMO

CMS defines a TPMO as any organization or individual compensated to perform lead generation, marketing, or enrollment activities for Medicare Advantage (MA) or Part D plans. That means independent agents and brokers fall under the TPMO umbrella whenever they market or sell these plans.

Why It Matters

The TPMO designation exists to ensure transparency, accountability, and consumer protection. CMS tightened these rules in response to misleading advertisements and beneficiary confusion. As a result, every agent who sells MA or Part D plans must meet strict communication and documentation requirements.

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Key Compliance Requirements

Here are the most important rules every TPMO must follow:

• Mandatory Disclaimer: Every piece of marketing material, website, or verbal outreach must include the approved CMS disclaimer: “We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.”
• Call Recording: Any phone call that discusses MA or Part D benefits; even informational calls must be recorded and securely stored for at least 10 years.
• Scope of Appointment (SOA): Always obtain an SOA before discussing plan details. Electronic and paper SOAs are acceptable but must be saved for recordkeeping.
• Avoid Misleading Language: Never imply government affiliation or say you offer “every plan” unless that is true. Be careful with phrasing on social media, websites, and mailers.

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Best Practices for Sales and Marketing

To remain compliant and build trust with clients:

• Lead with education, not sales. Help beneficiaries understand their options before recommending a plan.
• Use CMS-approved materials. Avoid customizing carrier pieces unless approved for agent use.
• Document everything. Keep records of calls, SOAs, and marketing pieces.
• Stay current on CMS updates. Rules can change annually; follow your FMO and carrier training closely.

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Being classified as a TPMO isn’t just a compliance label; it’s a reminder that agents play a critical role in maintaining Medicare integrity. By following CMS rules, staying transparent, and putting client education first, you protect both your license and your reputation in the Medicare marketplace.

Why Medicare Star Ratings Matter – Understanding Their Importance

When comparing Medicare Advantage or Part D prescription drug plans, you’ll see a “star rating” next to each one. These ratings aren’t just numbers; they reflect the overall quality and performance of a plan. Knowing why Medicare star ratings matter can help beneficiaries make a more confident, informed choice.

What Are Medicare Star Ratings

Each year, the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (MA) and Part D plans on a 1-to-5-star scale, with 5 stars being excellent and 1 star being poor.

CMS evaluates plans based on key measures such as:

• Preventive care and managing chronic conditions
• Member satisfaction and customer service
• Medication safety and accuracy of drug pricing
• Handling of complaints and appeals

These ratings help beneficiaries compare plan quality; not just costs.

Why Star Ratings Matter to Beneficiaries

1. Quality Over Cost
   A low monthly premium might look appealing, but a lower-rated plan could have poorer customer service or fewer care management programs. Star Ratings help you see the bigger picture.
2. Better Health Outcomes
   High-rated plans generally perform better in preventive care, chronic condition management, and prescription safety leading to improved member health.
3. Special Enrollment Advantage
   If a 5-star plan is available in your area, you can use the 5-Star Special Enrollment Period to switch once a year, even outside regular enrollment periods.

Watch a YouTube video on special enrollment periods

Why Star Ratings Matter to Carriers

For insurance carriers, these ratings are more than just feedback — they directly affect their business.

• Financial Rewards: CMS provides quality bonus payments to plans with ratings of 4 stars or higher. These bonuses can help carriers enhance benefits, reduce premiums, and remain competitive.
• Reputation and Market Growth: A higher-rated plan attracts more enrollees. Consumers often view Star Ratings as a trusted indicator of quality and satisfaction.
• Compliance and Accountability: Consistently low ratings can lead to penalties or even removal from the Medicare program. This motivates carriers to continuously improve service, communication, and care coordination.

In short, the Star Rating system drives both accountability and quality improvement for carriers and members alike.

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The Bottom Line

Medicare Star Ratings serve an important purpose for everyone involved. They help beneficiaries choose better plans, encourage carriers to maintain high standards, and ensure that Medicare funds support quality care.

When reviewing plans, remember; the stars tell a story about value, performance, and member experience. Taking time to understand them can make an important difference in satisfaction with healthcare coverage.

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