If you’re new to Medicare, you might think that all Medicare plans are the same in nature and performance. However, when you look to enroll in a Medicare Advantage or Part D coverage plan, you realize that your options are plentiful. 

Several private insurance companies offer several coverage plans, and each option varies greatly in terms of costs and coverage. So how would you know which one performs the best? 

Well, this is where Medicare Star Ratings come in.

What are Medicare Star Ratings?

Medicare Star Ratings is a system used by the CMS to assess and compare the quality and performance of Medicare plans, like Medicare Advantage (Part C) and Medicare Part D (prescription drug plan). 

The plans are rated from one to five stars every year in the fall, and beneficiaries use these ratings as a method to evaluate the overall performance of these plans.

More stars indicate more consumer satisfaction and better performance and quality of the coverage. So, this is how the ratings are assessed.

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

How are Medicare Star Ratings calculated?

CMS uses different factors to calculate star ratings for Medicare Advantage and Medicare Part D plans. For Medicare Advantage, the ratings are across different categories based on a comprehensive evaluation of various performance of Medicare star rating measures. 

The categories are:

Health outcomes 

The rating system measures how well the plan supports chronic disease management and preventive care, such as screenings, tests, and vaccines. 

It evaluates how often members receive or have access to preventive care services to stay healthy. The services include physical examinations, preventive screenings, and vaccinations like flu shots.

Managing chronic conditions 

It assesses how well the plan manages chronic conditions and offers beneficiaries support, like resources and different program recommendations, to maintain their health. 

Plans are also rated from one to five based on care coordination practices and how often members were recommended tests for long-term health conditions, such as diabetes, high blood pressure, arthritis, and osteoporosis.

Plan responsiveness and care

This category evaluates members’ experiences, like how responsive the plan was to their needs and how easy it was to book appointments, see specialists, and swiftly receive care. They rate the Medicare plans based on overall satisfaction.

Member experience 

Similar to the previous category, this one assesses how often members found problems or gaps in the plan and how well those problems were solved. 

The rating system also rates the improvements in performance over the years. It’ll have an above-average rating if the performance is good over the years.

Customer service 

The last evaluation is on how well the Medicare Advantage plan handles members’ inquiries and promptly and accurately resolves their issues. Moreover, the system also rates if the plan had foreign language interpreters and TTY services (for speech-impaired people) available.

How are Medicare Star Ratings calculated for Medicare Part D?

The Medicare Star rating system evaluates Part D plans while keeping the performance of the following aspects in mind.

Drug plan customer service

It measures the responsiveness of the plan when members inquire or raise concerns. It assesses how accurately and promptly they provide information to their beneficiaries. 

Member complaints, problems getting services, and choosing to leave the plan

Medicare Part D star ratings also include an evaluation of complaints received by the plan and how well they are addressed and resolved. Moreover, if someone chooses to leave the plan, the rating system will check how well the plan facilitates them. 

Member experience with the drug plan

The satisfaction of beneficiaries with the drug plan is a prominent measure of evaluating Part D coverage ratings. It includes customer service, access to prescriptions, and communication. 

Moreover, the coverage is assessed based on the number of drugs covered and the availability of generic alternatives.

Drug pricing and patient safety

Lastly, the Medicare Star program assesses Part D plans on whether their pricing is up-to-date and accurate on their website. If it’s inaccurate, the plan will receive a low rating from the Medicare star rating system. 

Moreover, they review the percentage of members who receive drugs with high risks of serious side effects when safer alternatives are available. If it is high, raising concerns about patient safety, the Medicare star rating system rates them low. 

Why are Star Ratings important to Medicare Advantage & Part D Plans?

Medicare created its rating system to rate different plans and provide you with an easy-to-understand and unbiased rating. 

When the coverage plans you want to take are similar in costs and coverage benefits, you can compare their ratings and make your judgment. The ratings will tell you how well the plan is performing and how satisfied its members are.

A high star rating means the plan is of high quality and performing well, whereas a low star rating, less than 3, indicates that it’s not up to the mark. Also, if a plan receives consecutively 3-star for three years, Medicare issues them a warning.

5 Star Medicare plans and SEP (Special Enrollment Period)

You can only enroll in a new plan during specific times, like annual open enrollment periods. 

However, if you’re switching to 5-star Medicare Advantage plans or 5-star rated Medicare Part D plans, you can use a Special Enrollment Period, which is a time outside of open enrollment timeframes. 

If you want to enroll in a 5-star plan, contact Medicare at 1-800-633-4227 and use the special enrollment period to switch your coverage at any time.

You can also use Hella Health’s Personal Shopper to compare plans and get personalized recommendations.

Questions about Medicare?

Shoot us an email at medicare@hihella.com.