What are the Medicare plan star ratings and how are they measured?

What are the Medicare plan star ratings and how are they measured?

The Star Rating system was created by the Centers for Medicare & Medicaid Services (CMS) to help Medicare beneficiaries and their families quickly compare the performance and quality of Medicare plans, including Medicare Advantage plans, Medicare Prescription Drug Plans, and Medicare Cost plans. 

All Medicare plans are rated on a 5-star scale: 

  • 5-star rating: Excellent
  • 4-star rating: Above Average
  • 3-star rating: Average
  • 2-star rating: Below Average
  • 1-star rating: Poor

Ratings for Medicare Health Coverage Plans

For Medical Health Coverage Plans including Medicare Advantage and Medicare Cost Plans, the plans are graded based on five categories. 

Staying Healthy: 

This takes into consideration the amount of access they give members to preventative services needed to keep them healthy. This includes physical examinations, vaccinations like flu shots, and preventive screenings.

Chronic Conditions Management:

This looks at how often their members are able to receive care for long-term or chronic conditions. 

Member Experience:

The satisfaction of a plan's members is taken into account. 

Member Complaints:

Plans receive a score based on how frequently members submit complaints about the plan or chose to leave the plan. This score is also based off how often members have issues receiving the services they need and if the plan is improving from year to year. 

Customer Service:

Plans are scored based on the quality of their call center services. They are also graded on how timely they process appeals and enroll new members. 

Ratings for Medicare Part D Plans

The star ratings for Medicare Part D Prescription Drug Plans and Medicare Advantage plans that include drug coverage will also look at member's experiences and their complaints, along with customer service. However they also take into account drug safety and pricing.

Drug Safety Score

A plan's drug safety score is based on criteria including how accurate the plan's pricing information is and how often members are prescribed medications in a safe, clinically recommended way for their specific condition. Plans are also graded by how up-to-date the pricing is on their website. There is also a grade for how often members are prescribed drugs that have dangerous side effects when a drug that is less dangerous could have been given. 

Assessing a Plan's Rating

A plan's overall rating gives you a quick summary of the plan's overall performance. However, to get a better idea, you can look into a plan's individual scores to get a better idea of what it offers. 

The ratings are prone to change from year to year and are updated every fall. Once you are enrolled in a Medicare Plan, check every fall to see how your plan's performance has changed. This will help you make an educated decision of whether to continue your plan or change to another. 

How to Enroll in a Medicare 5-Star Rated Plan

The Annual Election Period (AEP) is the time to sign up for a 5-star Medicare plan and runs every year from October 15th to December 7th.

If your current plan's rating is poor and you wish to change, you may do so within your service area one time during the 5-Star Special Election Period (SEP.) The SEP window is from November 30 to December 8. If you have just switched Medicare Advantage plans during your AEP, this SEP is only available in the following year.

If you choose to swap to a 5-star plan, be sure you new plan features prescription drug coverage, if you need this type of coverage. Otherwise, you may have to pay a late-enrollment penalty for adding drug coverage to your plan later. 

For help finding a Medicare plan, try our Medicare Cost Revealer. If you have any questions, please contact Medicare at any time at 1-800-MEDICARE (1-800-633-4227; TTY users 1-877-486-2048). 

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What are the Medicare plan star ratings and how are they measured?