What the Medicare Program Star Rating Means for You
Posted on February 16, 2024 By Jeff Snyder
While looking over different Medicare Part C or D insurance plans, you may have seen stars. This is the Medicare Program Star Rating system, which was designed to help enrollees be certain of the quality of a Medicare Advantage or Part D plan. Each fall, the Centers for Medicare & Medicaid Services updates these ratings, so you can make an informed plan choice during the Annual Enrollment Period.
What Does the Rating Mean?
Plans are rated anywhere from one to five stars (including half stars). Five is the best rating, while one is the worst. The greater the rating a plan has, the better its performance was that year. The star rating combines the scores of several different important categories for each plan.
Medicare Advantage plans with drug coverage are rated on 38 different measures, while plans without drug coverage have 28 measures. Stand-alone Part D plans are evaluated on 12 measures. These measures make up the star rating categories.
Medicare Advantage Star Ratings
Medicare Advantage plans are rated on five different categories — staying healthy, chronic conditions management, member experience, member complaints, and customer service.
Medicare Advantage plans are rated on five different categories — staying healthy, chronic conditions management, member experience, member complaints, and customer service. Staying healthy refers to the plan’s access to preventative services like screenings, exams, and vaccinations. How well and often the plan coordinates care and services for chronic illnesses determines the chronic conditions management rating.
The final three categories all link together in a sense. Member experiences is an evaluation of how happy enrollees are with the plan, while member complaints is how often official complaints are submitted. The latter also analyzes if there were issues receiving the services they needed. This category is also compared to previous years to see if there has been an improvement. Finally, customer service rates the call center and determines if appeals and enrollments are handled in a timely manner.
Prescription Drug Plan Star Ratings
Drug plans are rated on four categories — customer service, complaints and changes to the plan’s performance, member experience, and drug safety and accuracy of pricing.
Drug plans are rated on four categories — customer service, complaints and changes to the plan’s performance, member experience, and drug safety and accuracy of pricing. Generally, these are like a Medicare Advantage plan’s rating. The main difference is the final category.
CMS rates how accurately the plan’s price for a drug is. They’ll also analyze how often plan holders with certain conditions used their drug plan safely and in ways that are clinically recommended. These reviews are gathered through surveys, plan and billing reviews, and regular plan monitoring.
Now What?
Ratings provide a quick idea of the quality of the plan, making it easier to compare. Of course, this should only be the first step in your research. A quick glance at the ratings can help you narrow your options down, but it won’t tell you all the details. When it comes to your health care, the details, no matter how small, are of utmost importance.
That’s why it’s important to dig deeper whenever you can. A star rating will give you the overview of the quality of the plan, but it won’t tell you the premiums or copays. It won’t tell you ambulance fees or drug costs. It’s just another valuable point to compare.
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