Understanding Medicare Star Ratings
When looking for Medicare Advantage and Part D plans, you may have noticed stars appearing next to the plans listed. These are star ratings, and they may remind you of the type of ratings you see with online retailers. However, the star ratings for Medicare Advantage and Part D plans aren’t a measure of votes from customers. Instead, they’re an indicator of each plan’s overall quality — which makes them one of the best tools you can use to find the right plan for you.
What is the Medicare Star Rating System?
Medicare uses the Star Rating System to measure how well Medicare Advantage and Part D plans are performing. The ratings range from one to five stars:
***** Excellent Performance
**** Above Average Performance
***Average Performance
** Below Average Performance
* Poor Performance
Why are there Medicare Star Ratings?
Medicare Star Ratings exist to help customers understand the quality of each Medicare Advantage or Part D plan. Plans are closely monitored based on several important factors and criteria. The star rating system provides a way of clearly communicating how well a plan is doing in an easy-to-understand format.
What criteria are used to rate Medicare plans?
The criteria vary slightly depending on whether it’s a Medicare Advantage plan or a Part D Prescription Drug plan, but the most important factor is overall quality of care. That means what the plans cover, what that coverage looks like and whether it’s accessible to the average consumer.
Medicare Advantage Plans are rated on up to 40* different quality measures that generally fall into these five categories:
- Staying healthy by covering screenings, tests and vaccines
- Managing chronic (long-term) conditions
- Plan responsiveness and care
- Member complaints, problems getting services and choosing to leave the plan
- Health plan customer service
Part D plans are rated on up to 12 different quality measures that generally fall into these 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
Should I choose my Medicare plan based solely on star ratings?
The short answer is no. Star ratings are only intended as a guide to make finding high quality plans easier. The star rating system can help you research plans and find what works best for you. Before you consider star ratings, make sure whatever plan you’re considering fits your medical and financial needs. A five-star plan that doesn’t provide you with the right coverage for your personal circumstances won’t feel like a five-star plan to you.
What happens if I am enrolled in a low-rated plan?
If Medicare rates a plan with fewer than three stars for three consecutive years, the Medicare Plan Finder tool will list the plan as low performing. If this happens to a plan you are currently enrolled in, Medicare will notify you about it. You will not be removed from the plan, but it may motivate you to shop for a new plan during the next enrollment period.
What is the five-star Special Enrollment Period (SEP)?
Special Enrollment Periods occur outside of Medicare’s normal enrollment periods and are triggered by specific circumstances. If you want to enroll in a plan or change plans, you can take advantage of an SEP to join or switch to a five-star Medicare Advantage or Part D plan. The five-star SEP allows you to enroll in a Medicare Advantage Plan or stand-alone Part D plan that has an overall rating of five stars. You may only use this SEP once per calendar year.
This SEP begins December 8 of the year before the plan is considered a five-star plan (remember, ratings come out in October) and lasts through November 30 of the year the plan is a five-star plan. Enrollments in December are effective January 1, and enrollments from January to November are effective the first day of the month following the enrollment request.
The takeaway
Ultimately, Medicare star ratings are a tool to help you navigate your options in an informed way. If you’d like to explore your Medicare options but don’t know where to start, talk to one of our licensed insurance agents. We can help you find coverage that fits your needs and budget — and we work to provide five-star service to every client, every day.
Ede’m Now Health Marketplaceis a brand operated by Integrity Marketing Group, LLC and used by its affiliated licensed insurance agencies that are certified to sell Medicare products.Ede’m Now Health Marketplace is not endorsed by the Center for Medicare & Medicaid Services (CMS), the Department of Health and Human Services (DHHS), or any other government agency. Every year, Medicare evaluates plans based on a 5-star rating system.
