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Medicare Plan Star Ratings

Medicare Made Easy

Part D drug plans and Medicare Advantage Plans vary greatly in terms of costs and coverage. Each January, plans can change their coverage and costs for the new calendar year. This means that each fall, you should review your plan’s coverage and compare it with other plans in your area to make sure you have the coverage that is best for you. Examine a plan’s coverage, costs, drug coverage, and the pharmacies in its network to see if it best meets your current needs. After considering those factors, you can use the plan’s star rating from Medicare to help you make a final decision.

Medicare Plan Star Ratings

Medicare rates the quality of Medicare Advantage and Part D plans using a five-star rating system. Medicare Advantage plans cover hospitalization, outpatient care, and often prescription drug coverage. Medicare Part D drug plans help to pay for the cost of prescription medications.

When considering a new Medicare plan, it’s a good idea to review Medicare’s ratings to see how they stack up. These ratings are updated every fall. The more stars, the higher the rating with five stars being the highest.

You can check plan ratings online or by Phone

Medicare’s Plan Finder lets you search for health plans in your area by zip code. There you can see how the plans are all rated. Keep in mind new plans will not have a rating yet. You can compare up to three plans at a time. If you do not have internet access you can call 800-MEDICARE (1-800-633-4227) to get a plan’s ratings.

5 ways to use Medicare’s ratings to choose a Plan

  1. Look for a plan with a gold star by its name. That means it has the highest rating (5 stars). If a plan with 5 stars isn’t available where you live, be sure to select a plan with the highest star rating available.
  2. You can break a tie between plans. If you’re comparing plans that are similar in costs and coverage, you can identify and choose the one with the higher-quality rating. Weigh that against what you need in a plan.
  3. Switch your plan for a higher-rated one. You can change your plan once a year between October 15 and December 7.
  4. Find the highest rated plan for managing a chronic condition. Every plan gets an overall score for managing chronic conditions. There are also individual scores for certain specific conditions, such as diabetes, high blood pressure, osteoporosis, pain management, and rheumatoid arthritis.
  5. Get an idea of what it’s like to use the plan. Review a plan’s ratings on how many member complaints they get or how long it takes to get an appointment with an in-network doctor. Also, look at their ratings for overall member satisfaction.

What these ratings mean:

  • Five stars are excellent.
  • Four stars are above average.
  • Three stars are average.
  • Two stars are below average.
  • One star is poor.

Remember, if a plan has no rating, it’s new and there is no data accumulated yet for a rating to be done.

There are also plan’s service-specific ratings. Along with the overall rating, you can check how each plan rates for specific types of care. Service-specific ratings use the same one-to-five scale. For example, you might be interested in a plan’s rating on how long you have to wait for care, on their speed setting up appointments, or how they rate on flu vaccines.

What Medicare evaluates to rate the quality

Medicare uses information from many sources to do the ratings. This includes required data reporting from the health plan as well as surveys filled out by members of a health plan. Medicare also uses information obtained from health care providers.

Both health plans and prescription drug plans are evaluated on:

  • How a plan helps its members stay healthy: screenings, tests, and vaccines
  • The experiences members have had with a plan
  • What complaints members have had: trouble getting services, and choosing to leave the plan, along with whether the plan has improved in the past two years
  • The plan’s overall customer service

Along with the above, prescription drug plans are also evaluated on how well they handle their patient safety, including whether they give accurate information on drug prices.

In general, Medicare rates plans based on its member’s health, complaints, receipt of recommended care, and satisfaction. Some of the factors used to rate plans may be important to you and your health and satisfaction with the plan, and others not so much. Note, these ratings do not take into account whether the plans include high-quality hospitals and doctors in its network.

If Medicare gives a plan fewer than three stars for three years in a row, Plan Finder will flag the plan as low-performing. The symbol Plan Finder uses to show that a plan is low-performing is an upside-down red triangle with an exclamation point inside of it (similar to a caution sign). Medicare will notify you if the plan you are enrolled in is flagged as low-performing. You will not be removed from the plan, but you may want to check the plan’s costs and coverage to make sure it is still a good plan for you.

What is the five-star Special Enrollment Period (SEP)?

Generally, you can only change your plan or enroll in a new one during specific times. Special Enrollment Periods are periods of time outside normal enrollment periods, triggered by specific circumstances. If you want to enroll in a plan or change plans, you can take advantage of a SEP to join or switch to a five-star Medicare Advantage or Part D plan. This means that you can enroll in a Medicare Advantage Plan or stand-alone Part D plan in your service area that has an overall plan performance rating of five stars. You may only use this SEP once per calendar year.

This SEP begins December 8 of the year before the plan is considered a five-star plan (remember that ratings come out in October) and lasts through November 30 of the year the plan is a five-star plan
Enrolments in December are effective January 1
Enrolments from January to November are effective the month following the enrollment request

Summary

You can use Medicare’s five-star ratings to compare plans in your service area by the categories, listed above, which Medicare finds are important indicators of plan performance. Remember that a plan’s star rating is only one factor to consider when comparing plans. Even though a plan has a high star rating, it may not be the best choice for you. You should also consider the plan’s costs, coverage, and networks for providers and pharmacies.

Sonia Ashford, “The Medicare Insurance Lady”,  has been helping Medicare eligibles in Texas with their Medicare Insurance now since 2005. She has been married to John Ashford since 1982 and they reside in Bedford, Texas. They have six adult children and nine adorable grandchildren that they love to spoil. In Sonia’s limited spare time she enjoys quilting and crafting. 

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* A licensed sales agent may call or e-mail as a result of completing the information to discuss Medicare Advantage, Prescription Drug Plans or Medicare Supplement Insurance.