When choosing a Medicare plan, one important attribute to consider is a "Star Rating." The overall Star Rating gives a ranking of the Medicare plan's quality and performance for the types of services that each plan offers.
A higher Star Rating typically indicates a higher level of performance and reliability, which can be essential for beneficiaries seeking the best possible care. Understanding these ratings can help individuals make informed decisions that align with their healthcare needs and preferences. So, without further ado, here is what you need to know.
What You Need to Know About Medicare Star Ratings
Medicare plans are ranked from 1 to 5 stars (with 5 stars being the highest). If you are working with a licensed Medicare broker, they will inform you of a plan's Star Rating, or you can also verify a rating through Medicare or by contacting the plan directly.
If a plan receives lower than 3 stars for three years in a row, it will be flagged as a "Low Performing" plan. Medicare will notify you if you are enrolled in a "low-performing plan. You will not be automatically removed from the plan, but we could assist you with finding higher-performing plan options.
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Star Rating Categories for Health Service Plans
Managing Chronic Conditions: Rates how often members with specific conditions receive tests and treatments.
Screening Tests and Vaccines: Based on whether members get routine vaccines and preventive screening tests.
Health Plan Member Experience: This reflects how enrolled members rate (opinions) their specific plan.
Member Complaints: Tests how often Medicare found problems with the plan, how often members had problems with the plan, and how much (if any) of the plan's performance has improved.
Health Plan Customer Service: Measures how well the plan handles the member appeals.
Star Rating Categories for Prescription Service Plans
Drug Plan Customer Service: Measures how well the plan handles member appeals.
Member Complaints: Includes how often Medicare found problems with the plan and how often members had problems with the plan. Includes how much the plan's performance has improved (if at all) over time.
Member Experience with Plan’s Drug Services: Includes member ratings of the plan.
Drug Safety and Accuracy of Drug Pricing: Measures how accurate the plan’s pricing information is and how often members with certain medical conditions are prescribed drugs in a way that is clinically recommended for their condition.
Medicare Advantage plans (MAPDs) and Prescription Drug Plans (PDPs) use Star Ratings to show their quality and performance. On the other hand, Medicare Supplement plans, or Medigap plans, do not have Star Ratings, as they are standardized and follow Original Medicare guidelines, providing consistent coverage regardless of the insurer.
Here you can find current and past Star Ratings for Part C and Part D plans.
Medicare Part C and D Performance Data
With all of the information we've covered, it's clear to see that Star Ratings are an important distinguishing factor to consider when comparing different medicare plan options. However, Star Ratings alone will not give you clarity on which medicare plan is best suited for your individual needs.
Medicare Guidance You Can Count On
Even if a medicare plan has a high Star Rating, it's still important to confirm that your prescription medications are covered and that your doctors are in-network with that particular plan. Other factors like cost, coverage, travel and ancillary benefits are also things that our agents take into consideration when helping our clients compare plan options. At Twin City Underwriters, it's our goal to provide Medicare recipients with the Medicare education they need to make informed decisions with their healthcare choices. If you have questions about signing up for Medicare or your existing Medicare coverage, don't hesitate to reach out to our team today.
This is an updated blog that was originally published in 2018.
Choosing a Medicare plan can be difficult. Twin City Underwriters helps Medicare recipients in Minnesota, Wisconsin, North Dakota, South Dakota, Iowa and Florida find the Medicare plan that meets their unique needs. Schedule a one-on-one meeting with one of our Medicare insurance brokers to get your questions answered!
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