When choosing a health or prescription drug plan, it is important to consider the Medicare Star Ratings. What do these terms mean, and how can you use them to narrow down your Medicare plan options? Read on to find out.
The common misconception is that there is no difference between the various Medicare plans. However, this is not the case. Medicare Star Ratings are a quick and easy way to compare different plans and find the best one for your needs.
The effectiveness of Medicare plans is evaluated annually by the Centers for Medicare & Medicaid Services (CMS). The Star Rating System is the rating scale in use. The Centers for Medicare & Medicaid Services (CMS) compiles data from member surveys, health plans, and medical providers to assign an overall performance rating to each plan. Each plan is given a rating from one to five stars, with five being the best possible.
5-Stars is the highest rating
On average, only a small number of plans across the country receive the highest possible rating each year. Any plan with a rating of 4 stars or higher is considered superior by CMS. A 5-star rating, however, indicates that the plan is exceptional. If you go this route, you’ll be covered by a plan that prioritises its members’ health and provides superior support. If you’re in the market for a plan, it’s a good idea to see if any 5-star options are readily available in your area.
On the other end of the spectrum, a plan will be labelled as low-performing after receiving fewer than three stars from CMS for three consecutive years. Medicare and Medicaid Services (CMS) will notify you if the health insurance plan you’re enrolled in is performing poorly, giving you the opportunity to explore other options.
Medicare Advantage, Medicare Cost, and Medicare Part D prescription drug plans are all eligible for star ratings.
Medigap policies, which supplement Original Medicare, are not evaluated.
What is the 5-star Special Enrollment Period?
To join or switch to a Medicare Advantage, Medicare Cost, or Medicare Part D prescription drug plan with a 5-star rating, you can take advantage of a Medicare Special Enrollment Period (SEP) if one is available in your area.
The Special Enrollment Period for the highest-rated plans begins on December 8 and ends on November 30.
- All December enrollments will go into effect on January 1.
- All enrollments submitted between January and November will begin in the following month.
- Between the dates of December 8 and November 30, this SEP can only be used once.
What are CMS star ratings based on?
Medicare plans that provide health coverage – Such as Medicare Advantage and Medicare Cost plans – are given an overall rating based on their performance in 5 categories.
- Staying Healthy: The frequency and availability of screenings, physical exams, and vaccinations for members. This demonstrates how effectively the plan uses communication and reminders to keep members healthy.
- Managing Chronic Conditions: The rate at which members undergo recommended examinations and treatments for chronic conditions. The effectiveness of the plan in facilitating the provision of such services to members is reflected in these findings. Diabetes, high blood pressure, arthritis, and osteoporosis are just a few examples of conditions that may be addressed by various plans’ member-focused programs and resources.
- Member Experience: How happy members are with the plan overall, including how easy it is to see a doctor and get their prescriptions filled.
- Member Complaints and Performance: The frequency with which people found issues with the plan. The chart also shows how much the plan has improved annually.
- Customer Service: How often sign language interpreters and language interpretation services were made available. Timely handling of appeals and new enrollments also fall under this heading.
Medicare drug plans – In addition to the Member Experience, Member Complaints and Performance, and Customer Service categories discussed above, an overall rating is assigned to Part D prescription and Medicare Advantage plans that include drug coverage.
- Drug Safety and Accuracy of Drug Pricing: To what extent members are given medication that is both appropriate and effective for their condition, and whether or not the plan’s price lists are reliable.
Medicare plans are rated on a scale from 1 to 5 stars; to learn more about the criteria Medicare uses, please visit. Medicare.gov. You can also look up specific plan Star Ratings using the Medicare Plan Finder Tool.
When are Medicare Star Ratings updated?
Every fall, CMS releases the Star Ratings for the upcoming plan year. For example, plan ratings for 2022 will be available in October 2021. Star Ratings are calculated each year and may change from one year to the next.
If you’re enrolled in a Medicare plan, you should check your plan’s Star Rating every fall. Then you can make an informed decision about whether to stay on the plan or switch to a more highly rated plan.
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