One of CMS (The Centers for Medicare & Medicaid Services) most important Medicare goals is to make the quality of Medicare Advantage plans for their beneficiaries transparent. In this effort, advantage plans are each year are rated on a scale ranging from 1 to 5 stars. One star represents poor performance, while a five-star rating is considered excellent. Plan Ratings are published each year in fall, before the open enrollment period begins and beneficiaries may enroll in or switch plans.
In Medicare’s Plan Finder you will see 5-star plans marked with a gold star icon, and find an exclamation mark icon next to poor performing plans. The overall score makes it easy for Medicare beneficiaries to compare plans, based on quality and past performance.
How Are 5 Star Ratings For Advantage Plans In 2016 Determined?
In 2016, only contracts with more than 500 enrollees will be included in the Star Rating.
Medicare uses up to 44 different quality signals for MAPs (Medicare advantage plans) and MA-PDs (Medicare advantage plans that include prescription drug coverage). The information is taken from member satisfaction surveys and health care providers in order to give overall performance star ratings.
The criteria for MAPs covers the following topics:
The criteria for MA-PDs covers these topics:
For 2016, the availability of highly rated Medicare advantage plans has increased again. About 200 contracts, available to about 60% of enrollees, earned 4 to 5 stars for their overall rating. 12 MA-PDs (Medicare Advantage plans with prescription drug coverage) and 3 MA-only contracts received excellent 5 stars. 4.5 stars, the 2nd best rating, was given to 65 MA-PD plans while 102 MA-PD plans got a 4 star rating.
6 contracts however are marked with the low performing icon (LPI) for consistently low quality ratings in the past three years (i.e., 2.5 or fewer stars for Part C and/or Part D).
You can see the official list with low performing Medicare Advantage Plans, published by CMS.gov for each year here.
Medicare beneficiaries may enroll in, or switch between 5-Star rated advantage plans at any time during the year, provided they meet the requirements of the plan (having Medicare Part A and B, living within the plan’s service area, and not having end-stage renal disease).
Attention: If you switch from a MA-PD (a plan that includes drug coverage) to a MAP that doesn’t, you will have to wait until the next open enrollment period (Oct 15-Dec 7 each year) to enroll in a drug coverage plan, and you may have to pay a late enrollment penalty!By: Joseph Rosario