Comparing Medicare Advantage plans can be a challenging task. On the surface, they all look the same. How do you know which one is the best?
That’s one of the reasons the Centers for Medicare & Medicaid Services (CMS), the federal agency that governs the Medicare program, developed the Star Rating System. It’s based on 45 measures that rate the quality of Medicare health plans and how well they care for their members. A plan can get ratings between one and five stars. The more stars a plan has, the higher overall quality and service they offer.
The star ratings are there for you, the customer, to help you compare and contrast the performance of the Medicare plans you are considering. Ultimately, helping you select the best plan to meet your needs.
The measures that are used to determine the star rating fall into these main categories:
- Staying healthy: Are the members getting their preventive care (annual screenings, tests and vaccines) and other checkups that help them stay healthy?
- Managing chronic (long-term) conditions: This measurement is based on how often members with different conditions get tests and treatments that help them manage their condition.
The star ratings are there for you, the customer, to help you compare and contrast the performance of the Medicare plans you are considering.
- Member experience with the health plan: Here members rate their satisfaction with their plan. It also reflects the percentage of members that voluntarily chose to leave the plan.
- Member complaints and changes in the health plan’s performance: Includes how often CMS found problems with the plan and how often members reported complaints about the plan. This also measures if a plan’s performance has improved over time.
- Health plan customer service: Focuses on the plan’s approach to member appeals and how well and timely those appeals were handled.
- Drug safety and accuracy of drug pricing: Reports on how accurate the plan’s pricing information is and how often members with certain medical conditions are prescribed drugs in a way that is safe and clinically recommended for their condition.
CMS gathers this information from several different sources including member surveys and reviews of billing and other information that the plans submit. The organization then compiles the information in order to get a comprehensive look at the plan and attribute a star rating.
This research is conducted and updated on an annual basis so star ratings may change from one year to the next.
The Star Ratings should make comparing and enrolling in a Medicare plan a lot easier. Just start by looking at the plan’s rating and it will give you a quick snapshot of the quality of care and coverage that you’re likely to receive.
In Michigan, Priority Health’s HMO-POS plans has earned 4.5 stars for the last five years — no plan is rated higher — and its PPO plans earned 4 stars (out of 5). Check out prioritymedicare.com for more information.
