A lot of people think all Medicare plans are the same. But that’s not the case. An easy way to tell which plans are top performers is to check their Medicare Star Rating.
Each year, the Centers for Medicare and Medicaid Services (CMS) measures how well Medicare plans – medical and Part D prescription drug – perform. The scale that’s used is known as the Star Rating System. Ratings range from one to five stars, with five being the highest score a plan can get.
Getting five stars isn’t easy. Typically, only a handful of plans in the nation get a 5-Star Rating each year. So it says a lot about the quality of your plan. Medicare plans are rated on how well they perform in different categories. These scores are added together and the weighted average becomes the overall Star Rating. Scroll through the slideshow to learn about the categories. There are a total of nine different categories, but some are the same between medical and Part D plans. I combined a few to give you an overall look of what’s measured.
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Medicare Star Ratings
1. Staying healthy
How often members get preventive care (screenings, checkups, vaccines). This reflects how well the plan keeps members healthy through checkup reminders and other communications.
2. Managing chronic conditions
How often members get recommended tests and treatments to manage certain conditions. This reflects how well the plan helps members get these recommended tests and treatments. For example, plans may offer different programs and resources to help members manage certain conditions like diabetes, high blood pressure, arthritis and osteoporosis.
3. Member experience
How members rate their experience with the plan, including getting care from their doctor and getting prescription meds. This one speaks for itself!
4. Member complaints and changes in the plan’s performance
How often Medicare and members found problems with the plan. It also measures how much the plan’s performance improved over time.
5. Customer service
How often the plan had foreign language interpreters and TTY services available. This category also includes the fairness and timeliness of appeal decisions (if the plan received any).
6. Drug pricing and patient safety
How accurate the plan’s pricing information is and how often members are prescribed medicine in a way that’s safe and recommended for their condition.
Conclusion
Star Ratings can be a simple (and impartial) way to tell which plans in your area are high quality plans. And when it comes to your health, quality matters. To learn more about Star Ratings, visit medicare.govor checkoutthis article.
You can join a 5-Star plan year-round. If you’re unhappy with the plan you chose during Open Enrollment, you can switch to a 5-Star plan anytime throughout the year.
