What are Medicare STAR ratings

What are Medicare STAR ratings

CMS developed the Star Ratings system.  The system is used to rate both Medicare Advantage and Medicare Prescription Drug plans.  The star ratings are based on a scale from 1 (the lowest score to 5 (the highest score).  These ratings are based on the quality of each plan as well as the level of customer satisfaction.  The CMS looks at each plan’s performance on an annual basis.

Star ratings were put in place by CMS to improve the quality of the plans available to Medicare beneficiaries.  They are also a good way for CMS to track customer satisfaction with the care they receive from providers, hospitals and other healthcare facilities that work with Medicare beneficiaries.

How are the ratings decided:

Medicare Advantage (part C) and Medicare cost plans are rated based on their performance in the following 5 categories.

Members health

This is measured by member access and use of preventative services.  This includes physicals, vaccinations and screenings. This category shows how well a plan encourages members to use their preventative services through incentives and communication.

Chronic Condition management

This step monitors if members receive recommended treatments or testing for long-term health problems.  This shows if the plan provides encouragement and for members to get needed treatments and testing done. Each plan offers its own programs and resources for members to manage health conditions such as, diabetes, osteoporosis, arthritis or high blood pressure.

The experience of plan members

The member feedback is extremely important.  This category is based on how the members of a plan feel they were treated. Their experiences include the care they receive from doctors who participate with the plan as well as how they rate their ease of filling their prescriptions.

Complaints and plan performance

The number of complaints and problems beneficiaries report is tracked as well as if the plan has made improvements to address such issues.

Customer service

This also includes how appeals and new enrollments are handled.  Are they taken care of in a reasonable amount of time? Does the plan provide TTY services or interpreters for foreign language speaking clients.

Medicare Prescription Drug Plan Ratings

This includes (Part D) Prescription Drug as well as Medicare Advantage (MAPD) plans that include drug coverage.   These plans receive an overall rating which is decided by the same categories as above as well as drug safety and accuracy of drug pricing. The prescribing of medications is monitored to ensure safety and accuracy for each beneficiaries’ health conditions.

Very few plans get a rating of 5 stars

When a plan gets a rating of 5 stars, it is thought of as excellent.  If a plan has 4 starts, it is considered above average by CMS. Either of these ratings let a potential enrollee know they are considering a plan that offers good customer service and a solid benefits package.

However, if CMS gives a Medicare plan less than 3 stars for 3 years continually, it is marked as low performing. CMS will contact enrollees of low preforming plans so they can find better options if you want.