What is the 5-Star Medicare Rating System?
Medicare Part D Prescription Drug plans and Medicare Advantage (Part C) Plans are different in terms of costs and coverage by each carrier and in most cases, service areas. Every January, plans change their coverage and premium costs for the new calendar year, and each fall season, you should prepare to review your current plan’s coverage and costs in order to compare it to other plan options in your area. Medical needs and financial needs change throughout the year, and it’s important to ensure you have the coverage that is best for you. Examining a plan’s coverage, costs, drug coverage and the pharmacies in its network can be done with or without a licensed insurance agent. Medicare Pathways is here to help and offer no-cost, no-obligation annual reviews to ease the pain of researching benefits, formularies, and cost comparisons. Not only should you review the benefits, network, costs, and formularies – you should consider reviewing the Medicare Star Ratings.
What are the Medicare Star Ratings?
Medicare uses a Star Rating System to measure how well Medicare Advantage (Part C) and Medicare Part D Prescription plans perform. Medicare scores and reviews how well each plan performed in several categories Some of the categories include quality of care and customer service.
Medicare Star Ratings range from 1 to 5 stars, with five being the highest score and one being the lowest scored plan. Medicare assigns plans one overall star rating to summarize the plan’s performance as a whole, ensuring Medicare beneficiaries have an overview of their plan at a glance. These plans also get separate star ratings in each individual category reviewed, another opportunity for beneficiaries to review specifics on plans without diving deep into benefits, costs, and networks. The overall star rating score provides a way to compare performance among several plans.
Medicare reviews the plan performances each year and releases new star ratings each fall, just in time to conduct your annual reviews and begin comparing other plans in your service area. This means plan ratings change from one year to the next; this is why it’s so important to review your health plan options. Medicare sets the categories and reviews each plan the same way. You should look at coverage and plan costs, such as if the Medicare Part D Prescription plan covers all the drugs or medications, you take and has a premium you can afford throughout the year before you consider the star rating.
Here are the five different categories in which Medicare Advantage plans are rated:
1. Staying healthy: screenings, tests, and vaccines
2. Managing chronic (long-term) conditions
3. Plan responsiveness and care
4. Member complaints, problems getting services, and choosing to leave the plan
5. Health plan customer service
Medicare Part D Prescription Drug plans are rated on how well they perform in four different categories:
1. Drug plan customer service
2. Member complaints, problems getting services, and choosing to leave the plan
3. Member experience with drug plan
4. Drug pricing and patient safety
Where can I find information on my plan’s star rating?
The star ratings are public and can be found in the Medicare Plan Finder tool (www.medicare.gov/find-a-plan) or by calling 1-800-MEDICARE. New plan quality ratings come out each October, just in time for the Annual Election Period, and apply to the next calendar year (for example, plan ratings for 2018 will be available in October of 2017).
Note: The quality rating stars found on Plan Finder and by calling 1-800-MEDICARE are the most up-to-date and may differ from the ratings listed in the Medicare and You handbook you received in the mail. If you have any questions regarding the most current ratings, you can contact Medicare Pathways for further assistance.
How can I use the star ratings to inform my plan choice this year?
A plan’s star ratings are only one factor to consider when comparing plans in your area. Though a plan has a high star rating, it may not be right for you. You must consider if the plan fits in your budget and if it covers all of your medical needs (e.g., drugs and services you need.) It’s also important to determine if the plan includes the pharmacy you need in its preferred network.
If Medicare gives a plan less than three stars (only one or two stars) for three years in a row, Medicare’s Plan Finder tool will flag the plan as low performing. The flag looks like a caution sign; an upside-down red triangle with an exclamation point inside of it.
You cannot use the Plan Finder tool to enroll into one of these low-performing plans. You must call the plan directly to enroll.
If you are enrolled in a plan that gets one or two stars for three years in a row, Medicare will mail you a letter telling you this. You will not be removed from the plan, however, if you receive this letter, check the plan’s costs and coverage to make sure it is still a good plan for you. This would be an excellent time to reach out to Medicare Pathways and discuss your options.
For more information regarding the Medicare Star Rating System, contact Medicare Pathways at 866-466-9118 and speak with a licensed sales agent.