5 Star Medicare Advantage Plan Ratings 2016

Medicare health plan

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:

  • Staying healthy, including how often members got various screening tests, vaccines, and other check-ups that help them stay healthy.
  • Managing chronic (long-term) conditions, including how often members got certain tests and treatments that help them manage their condition
  • Health plan responsiveness and care, including ratings of member satisfaction with the plan
  • Member complaints and appeals, including how often members filed a complaint against the plan
  • Customer service, including how well the plan handles calls from members

The criteria for MA-PDs covers these topics:

  • Customer service, including how well the plan handles calls and makes decisions about member appeals
  • Member complaints and Medicare audit findings, including how often members filed a complaint about the drug plan and findings from Medicare‚Äôs audit of the plan
  • Member experience with the drug plan, including member satisfaction
  • Drug pricing and patient safety, including how well the drug plan prices prescriptions and provides updated information on the Medicare website, and how often members with certain medical conditions get prescription drugs that are considered safer and clinically recommended for their condition.

Gold star iconHigh Performing Medicare Advantage Plans 2016 (Gold Star)

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.

LPI low performing iconLow Performing Medicare Advantage Plans 2016 (LPI)

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.

The 5-star Special Enrollment Period

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

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