What are Star Ratings?

When you evaluate a Medicare Health Plan (Part C or Part D), you might notice that there are ratings for each plan.  Your Medicare professional should point these out to you. “The Centers for Medicare & Medicaid Services (CMS) publishes the Medicare Advantage (Medicare Part C) and Medicare Part D Star Ratings each year to measure the quality of health and drug services received by consumers enrolled in Medicare Advantage (MA) and Prescription Drug Plans (PDPs or Part D plans). The Star Ratings system helps Medicare consumers compare the quality of Medicare health and drug plans being offered so they are empowered to make the best health care decisions for them. An important component of this effort is to provide Medicare consumers and their caregivers with meaningful information about quality alongside information about benefits and costs to assist them in being informed and active health care consumers.” – cms.gov website

Medicare Advantage Plans

Medicare Advantage Plans are rated with five categories, that try to indicate your overall potential satisfaction with the program, should you choose it. These 5 categories are:

1. Member experience with the health plan: This is measured by members’ personal reviews of a plan.
2. Customer service: This is based on how well the plan responds to and handles member complaints and appeals.
3. Plan performance: This focuses on member complaints and changes in the plan’s performance. It includes how often Medicare found problems with the plan, how often members had problems with the plan, and how much the plan’s performance has improved over time, if at all.
4. Chronic conditions: This is based on how often members with certain long-term conditions were recommended tests and treatments to help manage their condition.
5. Staying healthy: This category measures whether members received various screening tests, vaccines, and preventive check-ups to help them stay healthy.

Recently, Medicare itself has changed the criterion to rate programs more harshly, with many programs seeing an overall downgrade in star ratings. Your experience may vary, and a lower star rating does not necessarily mean that your experience will be less than satisfactory.

Part D Prescription Drug Programs

Part D Prescription Drug programs are rated on four general categories, with 3 of the categories identical to how Medicare Advantage programs are rated.  Note that Medicare Advantage programs with a Prescription Drug Plan in the program, are rated strictly on the Medicare Advantage Star Ratings categories.  The four categories of rating are:

1. Member experience with the drug plan: This is based on members’ personal reviews of the Part D plan.
2. Customer service: This measurement is based on how well the plan manages member complaints and claim appeals.
3. Plan performance: This focuses on member complaints and changes in the plan’s performance. It includes how often Medicare found problems with the plan, how often people had problems with the plan, and how much the plan’s performance has improved (if at all) over time.
4. Drug safety and pricing: This category measures how accurate the plan’s pricing information is, and how often people with certain medical conditions are prescribed drugs in a way that is safer and clinically recommended for their condition.

The Significance of Star Ratings

Star ratings provide a summary way of comparing plans, costs, and coverage, as you shop for a Medicare plan. A 5-star rating is considered excellent. Medicare plans with 3 stars or less are considered poor quality and not likely to provide a satisfactory experience. 5-star plans, rated the highest overall, allow Medicare enrollees to switch to the 5-star plan without qualifying for a special enrollment period, between December 8 to November 30 of the following year.

If you are presented with a plan option for Medicare Advantage or Medicare Part D, the consultant is required to show you and discuss the star ratings of the plan with you.