What Are Medicare Plan Star Ratings and How Are They Measured?

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Medicare star ratings are an objective measure for you to compare private Medicare Advantage and Medicare Part D plans based on the quality of care and performance. These plans can vary significantly in regard to costs and coverage.

Medicare Advantage and Part D drug plans change every January, so you should assess your options annually as you look at ratings along with a plan’s network, drug and medical coverage, out-of-pocket costs, and pharmacies. All of these factors can tell you if a plan meets your needs.

After you have evaluated and narrowed down specific plans that fit your needs, you can use star ratings from Medicare to make your best choice.

How Does the CMS Star Rating System Work?

Centers for Medicare and Medicaid Services (CMS) uses a star ratings system to evaluate and advise you of how well a Medicare Advantage Plan and Part D drug plan performed in the previous year.

These ratings are based on multiple factors, including quality of care and customer service, and are individually ranked for each category. Then, Medicare assigns an overall star value to give you a high-level overview of each plan’s performance.

What is the highest Medicare star rating?

Medicare star ratings are judged on a 5-star rating system. A 1-star rating indicates a very poor overall performance and a 5-star rating indicates a very high-performing plan.

Understand the overall ranking system meanings:

Ranking Quality
5-star rating Excellent
4-star rating Above Average
3-star rating Average
2-star rating Below Average
1-star rating Poor

What Are CMS Star Ratings Based On?

Star ratings are influenced by five subcategories for Medicare Advantage Plans and four subcategories for Medicare Part D plans.

How are Medicare Advantage Plans rated?

Medicare Advantage plans are evaluated on five criteria to determine the plan’s overall score. These include:

  1. Customer service: Call center services, such as availability of TTY and interpreter services for non-English speaking beneficiaries, and the timely processing of appeals and new enrollments.
  2. Chronic conditions management: Ratings for care coordination and how often members receive care for long-term health conditions.
  3. Member complaints: How frequently plan members submitted complaints concerning receiving services or left the plan.
  4. Member experience: The overall satisfaction of the health plan.
  5. Staying healthy: Access and participation in preventive services, including flu shots, other vaccinations, and preventive screenings for common conditions such as diabetes and cardiovascular disease.

How are Part D plans rated?

Part D plans have four evaluating criteria, including three that are found in the Medicare Advantage categories:

  1. Customer service:Call center services, such as availability of TTY and interpreter services for non-English speaking beneficiaries, and the timely processing of appeals and new enrollments.
  2. Member complaints: How frequently plan members submitted complaints concerning receiving services or left the plan.
  3. Member experience: The overall satisfaction of the health plan.
  4. Drug safety and drug pricing accuracy: The plan’s pricing accuracy and if drugs are prescribed in a way that is safe and appropriate for your condition.

How Do You Find CMS Star Ratings for 2022?

The Medicare Plan Finder details the latest CMS star ratings for every plan. The plan finder allows you to search Medicare Advantage and Part D plans that are specific to your area and is the easiest way for you to find these star ratings online.

CMS also prints an annual report on the methodology of scoring and plans company ratings. It also includes overall statistical information concerning historical information about the Medicare Part C and D usage for the program.

You can also contact Medicare directly at (800) MEDICARE to ask about ratings.

What Should You Consider Before Choosing a 5-star Plan?

Five-star plans are superior, but don’t blindly follow a rating as you choose a plan. First, consider how a plan meets your needs. When selecting a plan, you should consider the following before you look at star ratings:

  1. Cost: When you consider costs, don’t just consider monthly premiums. Consider the total costs associated with your medications, medical services, and premiums.
  2. Network: Most, if not all, Medicare Advantage and Part D plans have networks. Even if you have a preferred provider organization (PPO) network, you will pay less if your doctor is in-network. The same is true for drug plans. The plan contracts with certain pharmacies at different levels for your drugs. When you use the in-network providers, you pay less.
  3. Formularies: This is a list of the drugs that your Medicare Advantage or Part D plan covers, and how drugs are billed. Each company has a different formulary for its members. When your drug is not covered, you may have to get a different prescription for the condition or request an exception from the plan.

Star ratings are more important when you have a few plans that are very similar and you are looking at which offers the best value for your money.

How Do You Enroll in a 5-star Medicare Plan?

Enrolling in a five-star Medicare plan is similar to enrolling in any Medicare Advantage or Part D drug plan. You have four main periods where you can choose a plan or make changes to your Medicare coverage:

  1. Initial Enrollment Period: When you first qualify for Medicare at age 65. This period includes the seven-month period of the three months before you turn 65, the month you turn 65, and three months after you turn 65.
  2. General Enrollment: This enrollment occurs annually between January 1 and March 31, when you can enroll if you missed your Initial Enrollment Period.
  3. Annual Open Enrollment: This enrollment occurs annually between October 15 and December 7 each year. You can switch Medicare Advantage or Part D plans, or switch between Medicare Advantage from Original Medicare and vice versa. All decisions during this period go into effect on January 1 of the next year.
  4. Special Enrollment Periods (SEPs): SEPs apply if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

If you’re currently in a Medicare Advantage Plan and enroll in a Part D stand-alone plan, you will likely lose your medical coverage from Medicare Advantage and revert to Original Medicare.

What is the 5-star Medicare Special Enrollment Period?

Five-star plans have a unique feature that no other Medicare Advantage or drug plan has. If there is a 5-star plan available in your area, you can make a single change from your current Medicare plan to the 5-star plan using the 5-Star Medicare SEP.

This SEP can be used between December 8 through November 30 each year. Between this SEP and other types of enrollment periods, you can join a 5-star plan at any point of the year.

When Are Medicare Star Ratings Updated?

Star ratings are published by CMS annually in the fall, around October. This allows you time to review the new ratings during the Annual Enrollment Period (AEP) and make changes that go into effect the next calendar year.

Travis Price
Medicare consultant

Travis Price is a licensed independent health insurance agent specializing in Medicare private insurance programs, including Medicare Advantage and Part D drug plans. Price has been in the Medicare industry since 2004, first in South Carolina and now in the Traverse City, Michigan, area.

He earned a bachelor’s degree in business management and accounting from Baker College. Price has worked with hundreds of Medicare-eligible beneficiaries to ensure they get the best plan to fit their medical needs without forcing them to pay for coverage that is unnecessary, saving them hundreds of dollars per year in health insurance costs.

Price supports his clients as an advocate, informing Medicare beneficiaries of their options and answering questions. He’s an active Medicare and insurance contributor on LinkedIn, Quora, and YouTube.

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