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Many people have probably heard about some Medicare insurers suing CMS over their Star Ratings. This may lead to questions about Why Medicare Star ratings are important.

Star Ratings are determined annually by the CMS (Centers for Medicare and Medicaid Services). The ratings apply to Medicare Advantage and Part D (prescription drug plans).

They can help enrollees decide which plan is best in areas that are important to them. Choosing the right plan can impact both healthcare and finances. That is why CMS developed the Star rating system

What Are Star Ratings

Medicare Star Ratings evaluate the quality and performance of Medicare Advantage (Part C) and Medicare Part D prescription drug plans. Each plan is rated on a scale from 1 to 5 stars, with 5 being the highest. These ratings are updated each year and are based on many factors such as:

Customer satisfaction: This is based on customer ratings of each plan.

Clinical outcomes: How effective is the plan at keeping it’s members healthy.

Customer service: How do customers rate the responsiveness and support they received from plan representatives.

Drug safety and accuracy: This applies to Part D plans and it helps ensure safe and correct use of prescription drugs.

Why Medicare Star Ratings matter

1. Assessing Plan Quality: Star ratings give beneficiaries an easy-to-understand measure of a plan’s overall quality. Higher-rated plans generally provide better services, improved outcomes, and higher levels of customer satisfaction.
2. Influencing Plan Selection: Many beneficiaries use star ratings as one of the deciding factors when they compare plans. A higher star rating may mean a plan is more likely to meet healthcare needs.
3. Access to Special Enrollment: If a plan receives a 5-star rating, it qualifies for a Special Enrollment Period (SEP). This allows beneficiaries to switch to a 5-star plan one time per calendar year outside of standard enrollment periods. This can be crucial for individuals looking for better coverage options.
4. Improved Health Outcomes: Plans with higher ratings often prioritize preventive care, chronic condition management, and overall wellness. This can lead to better health outcomes for members.
5. Impact on Plan Providers: Medicare Star Ratings incentivize providers to improve their performance. Plans with higher ratings may receive additional bonuses from CMS, which can lead to reinvestment in member benefits and services.

Other things to consider

Although Medicare Star Ratings are essential, they shouldn’t be the only factor anyone’s health coverage decision. Here are some additional considerations:

Plan costs: Enrollees must compare premiums, deductibles, copays, and out-of-pocket maximums.

What the plan covers: It is imperative to be sure the preferred doctors & hospitals are in network as well as coverage of necessary medications.

Individual needs: Although one plan may have a lower rating than another it still may be a better choice for the individual depending on personal preferences and needs.

Use Star Ratings

Licensed Medicare agents can help compare plan options as well as using Medicare’s Plan Finder tool to compare plans and view star ratings. Be sure that details about coverage, costs, and benefits are clear before making a choice.

Medicare counselors, brokers, agents, or state health insurance assistance programs (SHIPs) can help interpret ratings and assist beneficiaries in choosing the best coverage.

Medicare Star Ratings are a way to evaluate quality and performance of Medicare Advantage and Part D plans. Understanding what the ratings mean and how to use them effectively, can help beneficiaries make informed decisions about healthcare coverage.

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Sign up for Medicare Part D

Once you enroll in Medicare, it is very important to Sign up for Medicare Part D.  A skilled Medicare agent can make choosing the best Medicare Part D (prescription drug plan) reasonably quick and easy.  Anyone who does not have credible Part D coverage when they are eligible for Medicare is subject to a lifelong penalty.

What does Medicare Part D cover:

Medicare Part D plans are prescription drug coverage.  This coverage is available to eligible Medicare beneficiaries. Part D coverage is provided by private insurance companies that are contracted with the federal government. There are 2 ways to enroll in Part D coverage.  First, beneficiaries may enroll in a PDP, stand-alone prescription drug plan, in addition to traditional Medicare.  The second choice is to enroll in a Medicare Advantage plan, MAPD these plans include Part D coverage.

Who is eligible for Medicare Part D:

If you are enrolled in either Medicare Part A or Part B and live in the Part D plan’s service area, you are eligible to enroll in a plan.  Additionally, certain individuals with limited income and resources are eligible for “extra help”.  Extra help provides help paying for drug plan premiums, deductibles, coinsurance and other costs.  Click here to learn more about “Extra Help” and how to apply.

When can you enroll in Part D:

To avoid late enrollment penalties, timely Medicare Part D enrollment is imperative. There are two primary enrollment periods.

The IEP or Initial Enrollment Period is a 7-month period.  It starts three months before you turn 65, includes your birth month, and ends three months after your birthday. Please note; if you qualify for Medicare due to a disability, you may have different enrollment periods.

AEP or Annual Enrollment Period occurs each year from October 15th to December 7th. During the AEP, you can make changes to your existing Part D coverage, such as switching plans or adding coverage.

How to choose a Medicare Part D Plan:

This is an extremely important part of your Part D enrollment.  If you choose the wrong plan, it can be a very costly mistake.  Each plan offers different coverage options. Selecting the right Part D plan is crucial, as each plan may have different premiums, coverage options, and their own network of pharmacies. Please consider the following when making a plan choice:

Make a list of all the medications you are currently on.  You may want to add in anything that your doctor will prescribe in the following months. Be sure to include the dosage and the frequency  that you take them.  This helps to find plans that cover your medications.

An insurance agent can show you a comparison of the best plan options for your needs.  If you  do not have an agent, use the Medicare Plan Finder tool on the official Medicare website. Be aware of all costs including; premiums, deductibles, copayments, and coinsurance costs.  You need to consider the total cost of each plan option.

Look at the plan’s formulary.  This is a list of drugs covered by each plan. Double check that your medications are on the list and make a note of any restrictions on your prescriptions.

Be sure the pharmacy you use is a preferred in-network. If it is not see if there are alternative pharmacies close by that are preferred in-network so you can receive the best pricing.

Check the plan’s star ratings.  This is  system based on overall service and coverage.

How to enroll in Part D:

Once you choose the best Medicare Part D plan to meet your prescription coverage needs, you have a few ways to enroll.

1.  Online: A licensed Medicare agent may be able to enroll you using an enrollment link from their quoting engine or you can enroll by going to either Medicare.gov or the website of the carrier of the plan you selected.

Click here to view a demo of how to use Sunfire to run a quote

2.  Fill out a paper application.  If you are working with an agent, they will help you fill out the necessary paperwork and send the application in for you.  If you do not have an agent, you can submit the application using the instructions provided by the carrier.

3.  Enroll over the phone.  You can call the plan carrier or call 1-800-633-4227 (1-800-Medicare).

Beware of late enrollment penalties:

If you miss your Initial Enrollment Period or do not have creditable prescription drug coverage for over 63 days, you may wind up with a late enrollment penalty. This penalty is added to your Part D premium and remains in effect for as long as you have Part D coverage.  Please note; if you receive extra help, this penalty does not apply.

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