What Choice Do I Have?
This is the second article of a four-part series to help individuals navigate the complexities of healthcare. We received many questions and comments from individuals related to the last article about preparing for Open Enrollment. In this blog, we will explore what to look for when selecting Medicare Advantage plans.
One of the factors that people need to review before signing on the dotted line for health insurance is the insurance plans’ star rating.
The star rating is an important measure provided by the Centers for Medicare & Medicaid Services (CMS) based on a comprehensive evaluation of each Medicare Advantage plan’s performance across several key quality measures. Plans that have Medicare Part D prescription plans and those that don’t offer that benefit are rated. These star ratings are designed to provide beneficiaries with a clear, easy-to-understand indication of the quality of care and service provided by a plan. The ratings range from 1 to 5 stars, with 5 being the highest rating.
Understanding Medicare Star Ratings
Here is what the star rating tells you about a Managed Care plan:
Overall Quality and Performance:
Star ratings summarize a plan's overall quality and performance across several categories, including health outcomes, customer service, and member satisfaction. Higher star ratings indicate better quality and performance.
5 stars: Excellent
4 stars: Above average
3 stars: Average
2 stars: Below average
1 star: Poor
Each plan is rated across multiple areas of performance. Below are the major areas:
Member Experience and Satisfaction: Surveys of plan members regarding their satisfaction with the plan and their care.
Quality of Care: How well the plan helps members manage chronic conditions, preventive care, screenings, and overall health outcomes.
Customer Service: Quality of customer service, including how quickly and effectively the plan responds to member inquiries and appeals.
Complaints and Disenrollments: The frequency of complaints about the plan, members choosing to leave the plan, and any issues regarding plan performance.
Drug Safety and Accuracy (for plans that include Part D coverage): Ratings on how safely and accurately the plan provides prescription drugs, including managing medications for chronic conditions.
Once you evaluate the star rating, what does it matter?
1. Plans with consistently high star ratings (4 stars and above) are more stable, with fewer issues related to customer service, complaints, or disenrollment.
2. Higher-rated plans are typically more effective at helping members manage chronic conditions, complete preventive screenings, and maintain overall health.
3. Medicare provides financial bonuses and higher reimbursement rates to plans with 4 stars or higher. This additional funding often allows high-rated plans to offer better benefits, lower costs, or additional services to members.
As you begin to select a Medicare Advantage Plan keep these three (3) tips in mind:
Look Beyond the Overall Rating: Examine ratings for specific categories like member satisfaction, customer service, and managing chronic conditions to get a complete picture of the plan's quality.
Consider Your Needs: Choose a plan with high ratings in areas that are most important to you, such as customer service or care coordination.
Check Annually: Star ratings can change each year, so review your plan’s rating during the Annual Enrollment Period (October 15 – December 7) to ensure it still meets your needs.
You can find the star ratings for Medicare Advantage (also called MA or Medicare C) plans by using the Medicare Plan Finder. It is the most reliable and comprehensive source for Medicare Advantage plan information , including up-to-date star ratings directly from Medicare: https://www.medicare.gov/plan-compare/#/?year=2024&lang=en