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What do Medicare Advantage Plan’s Star Ratings Mean?

Medicare Advantage plans are rated by the Center for Medicare Services on a rating system of 1 to 5 stars. One star is given to the worst plans, with 5 stars being given to the best plans. In 2015, 16 Medicare Advantage plans were given a 5-star rating, and CMS noted a significant year-over-year increase in top performing plans. In addition, plans there was an 80% decrease in plans that “received a ‘low-performing icon’ designation for the 2015 star ratings compared to 2015.”

The takeaway is that as a whole, Medicare Advantage plans continue to improve in quality every year. So how do you interpret the 5-star rating system? Learn more in our blog.

Medicare Advantage Star Rating System

Medicare uses a lot of criteria to rate Medicare Advantage plans. More than 30 different measurements are used for Medicare Advantage plans, and more than 15 are used for Medicare Advantage plans that include drug coverage. Where does Medicare get this information? It comes from health care providers and member satisfaction surveys.

The quality measurements are grouped into the following general areas:

Medicare Advantage

Staying Healthy

How often do members get check-ups, screening tests, vaccines, and other preventative treatment designed to help them stay healthy?

Managing Chronic Conditions

How often to plan members get tests and treatment to help manage their condition?

Member Experience

How satisfied are members with the plan?

Member Complaints and Changes in the Plan’s Performance

How often have members had problems with the plan? How often has Medicare found problems with the plan? How has the plan’s performance fared over time?

Customer Service

How well does the plan handle member appeals?

Medicare Advantage Plans with Prescription Drug Coverage

Customer Service

How well does the plan handle member appeals?

Member Complaints and Changes in the Plan’s Performance

How often has Medicare found problems with the plan? How often have members had problems with the plan? How has the plan’s performance fared over time.

Member Experience

Ratings of member satisfaction with the plan.

Drug Safety and Accuracy of Drug Pricing

How accurate is the plan’s pricing information? How often are members with certain medical conditions prescribed drugs in a way that is safer and clinically recommended for their condition?

medicare-advantage-ratings

For a full list of the criteria used to rank Medicare Advantage plans, click here.

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