What are Medicare Star Ratings?
Medicare star ratings rank Medicare plans from 1 to 5 stars, with 5 being the highest. Any plan that has lower than 3 stars for three years in a row will be flagged as a “low performing” plan. Medicare will notify you if your plan reaches this threshold, but you will not be removed from the plan automatically.
Five-star Medicare plan ratings only make up about 5% of all Medicare Advantage plans. But over half have 4-star ratings or above. When plans have a 5-star rating, you may switch to that plan at any time, regardless if you are in an enrollment period or not.
Star Rating Categories
Medicare Advantage plans are rated on how well they perform in these different areas.
- Staying healthy; screening tests and vaccines: This rating measures vaccines and screening tests. If plan members get vaccines and/or screening tests often, the rating will increase accordingly.
- Managing chronic conditions: This measures how often members with specific conditions receive tests and treatments. The fewer users receive treatments, the lower the star rating.
- Member complaints: This rating category tests how often Medicare members had problems with their plans, how often they had problems, and how much the plan’s performance has improved.
- Plan customer service, responsiveness and care: This rating category measures how well the plan handles member appeals. If there are any grievances, complaints, or reconsiderations by the member, they will appear here.
An additional category applies to Part D (prescription drug) plans:
- Drug safety and accuracy of drug pricing: This category measures the accuracy of the plan’s pricing information. In addition, it shows how often members with medical conditions are prescribed drugs in a way that makes sense and is clinically recommended for their condition.
Medicare star ratings are there to help you decide what plan works best for you. If you are having trouble understanding the ratings or making your plan decision, reach out to our team to help you through the process!