What Are Medicare Plan Star Ratings?

Medicare collects information from Medicare member surveys, plans, and healthcare providers to give the plan’s performance star ratings. This plan star rating began in July 2016 and is now published yearly. A plan can rank from one star to five stars, with five stars being considered excellent. This star system rating applies to Medicare Advantage plans and Medicare Part D plans. They are judged in several categories, two of them being customer service and quality of care. Even though each plan is ranked in each individual category, it is also given an overall single star rating to rate the plan’s performance as a whole. These results are released by The Center for Medicaid and Medicare Services (CMS) each fall. 

Medicare Advantage Star Ratings 

Medicare Advantage star ratings are awarded depending on rankings in five categories:

  • Staying healthy: screening, tests, vaccines
  • Managing chronic or long-term conditions
  • Plan responsiveness and care
  • Member complaints, problems getting services, and choosing to leave the plan
  • Health plan customer service 

It is also important to pay attention to the subcategories as well. For example, “staying healthy” includes vaccines and patients reporting improvement in their physical health over a two-year span. “Managing chronic conditions” is determined from a few different data points, such as diabetic patients receiving recommended screenings or rheumatoid arthritis patients receiving proper medications. 

Medicare Part D Star Ratings 

Medicare Part D is also referred to as the prescription drug plan offered by Medicare. Medicare Part D plans receive their star ratings based on the judgment of four categories:

  • Drug plan customer service
  • Member complaints, problems getting services, and choosing to leave the plan 
  • Member experience with the drug plan
  • Drug pricing and patient safety

CMS bases the drug safety score off of two items:

  • Accuracy of the drug cost according to the plan provisions.    
  • How often members with certain conditions are prescribed medications that are safer and clinically recommended for their specific condition. 

Both plans are rated according to the accuracy of their drug pricing information on their website as well. 

5-Star Special Enrollment Period

If you desire to switch to a five-star Medicare plan, you are allowed the opportunity to do so, according to the law. You have the option to switch plans during the Five Star Special Enrollment Period (SEP), which occurs from December 8th to November 30th. You also have the opportunity to switch plans during the Medicare Advantage Open Enrollment Period. You may switch to any Advantage plan during this time. 

While switching to a five star Medicare plan is enticing, there are certain aspects you have to remember:

  • If your current Medicare Advantage plan provides drug coverage and you switch to a five-star plan, you may lose your prescription drug coverage if your new plan does not offer it. 
  • If you do lose your drug coverage, you may not be able to re-enroll until the next enrollment period.

Give Us A Call Today

If you’re interested in learning more about plan star ratings and finding a plan that works for you, reach out to us today. Our agents are here to help you get the Medicare coverage you deserve!