What Are Medicare Star Ratings? How To Find and Choose A 5-Star Plan
Each year, the CMS publishes Medicare Star Ratings to measure the quality of services eligible enrollees received. Learn more about the rating criteria and process.
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Key Takeaways:
Medicare Star Ratings evaluate health and drug plans across 45 quality and performance measures
Plans are assigned a rating on a one- to five-star scale
You can research and compare plans with the Medicare Plan Finder
You can take advantage of the 5-star Special Enrollment Period, which runs from December 8 to November 30 of the following year.
If you are one of the millions of people enrolled in a prescription drug plan (PDP), you know that your costs and coverage can change from year to year. To ensure that you have the coverage you need for your necessary medications, it is important to review your policy every year.
The Centers for Medicare and Medicaid Services (CMS) publishes its Medicare Star Ratings annually to help you make an informed decision about which plan is best for you. Each plan is evaluated across 45 quality and performance measures, allowing you and your healthcare provider to view all the differences between them, then pick the best prescription drug coverage for your needs. Read on to find out more about Medicare Star Ratings.
How Do Medicare Star Ratings Work?
CMS evaluates health and drug plans and assigns them a rating on a 1- to 5-star scale, with one representing the poorest performance rating and five representing excellent performance.
5-star rating: Excellent
4-star rating: Above Average
3-star rating: Average
2-star rating: Below Average
1-star rating: Poor
The 5-star rating system evaluates Medicare Advantage plans on the following criteria:
Beneficiaries stay healthy and have access to screenings, vaccinations, and tests
Beneficiaries can manage chronic, long-term health conditions
Members are generally satisfied with their providers
Members are typically satisfied with their plan's performance
Beneficiaries received timely customer service
Medicare Part D plans are measured in the following areas:
Drug cost and patient safety
The overall experience of beneficiaries
Problems and member complaints
Customer service
If a plan is given three stars for three years in a row, you will receive a notification that the plan is low-performing. While you can still stay with the plan if you wish, after receiving such information about a poorer rating, it is a good idea to review your options to and can consider selecting a better-performing plan if doing so could lower your costs.
CMS released its 2020 plans with a 5-star rating last year. Here are the plans that earned top marks:
Medicare Advantage and Part D plans
Anthem's Healthsun Health Plans in Florida
Cigna's HealthSpring of Florida
CVS Health's Aetna Health in Maine
Guidewell's Florida Blue Medicare
HealthPartners' Group Health Plan in Minnesota, Wisconsin, South Dakota and North Dakota
Humana's CarePlus Health Plans in Florida
Kelsey-Seybold Administrators in Texas
Kaiser Foundation Health Plan in California
Kaiser Foundation Health Plan of Colorado
Kaiser Foundation Health Plan of Georgia
Kaiser Foundation Health Plan in Hawaii
Kaiser Foundation Health Plan of The Mid-Atlantic States
Kaiser Foundation Health Plan of The Mid-Atlantic States (different contract)
Kaiser Foundation Health Plan of Washington
Martin's Point Generations Advantage in Maine and New Hampshire
Quartz Health Plan Minnesota Corp.
Tufts Associated Health Maintenance Organization in Massachusetts
UnitedHealth Group's Care Improvement Plus South Central Insurance Co. in New York
UnitedHealthcare Benefits of Texas
University of Wisconsin Hospitals and Clinics' Quartz Health Plan Corp.
Medicare Advantage only
Medical Associates Health Plan in Iowa, Illinois and Nebraska
Part D only
Anthem Insurance Co. & Blue Cross Blue Shield of Massachusetts, Rhode Island and Vermont
Lifetime HealthCare's Excellus Health Plan
How Can You Look Up a Plan's Rating?
To obtain more information about a specific plan, you can access traditional Medicare customer service tools that are available to you. These tools include a paper copy of the "Medicare & You" handbook, which is mailed to all Medicare households each fall. If you prefer a digital version of the handbook, you can sign up to download it electronically. You can also get help by calling 1-800-MEDICARE.
The great news is that there is a new tool available that you can use to look up the Medicare Advantage and Part D ratings on your own: the redesigned Medicare Plan Finder.
You can shop for and compare Medicare plans on this platform. You can also build a personal drug list, compare pricing, and see plans side-by-side to find out which plan is best for you.
When Can I Join a Health or Drug Plan?
Unfortunately, you cannot enroll in a Medicare Advantage Plan or Medicare prescription drug plans whenever you want. Instead, you can only enroll during certain enrollment periods.
Open Enrollment for Medicare Advantage and Medicare prescription drug coverage runs from October 15 to December 7. You can also switch your Medicare Advantage plans or join a Medicare prescription plan during the Medicare Advantage Open Enrollment Period between January 1 and March 31. The 5-star Special Enrollment Period, which allows you to switch to a 5-star Medicare Advantage or Part D plan once per year, runs between December 8 to November 30 of the following year.
The Bottom Line
We all want to find the best coverage possible, and the Medicare Star Ratings can be a great guide to help you achieve that goal. When you are ready to enroll in a Medicare plan, check the Medicare Part D and Medicare Advantage Star ratings to compare the costs and quality of care rankings to find the right plan for you.
Kat Tretina is from Orlando, Florida and specializes in writing about finance and healthcare.
