What are CMS Star Ratings?
When comparing either Medicare Advantage (MA) plans or Prescription Drug Plans (PDPs) you may have heard or come across the ‘Star Rating’ for a plan. The Star Rating of a MA or PDP plan is given by the Center for Medicare and Medicaid Services (CMS) which is the federal agency that administers Medicare to measure how plans perform.
Each year the CMS uses information from member satisfaction surveys, plans, and health care providers to give overall performance star ratings to plans. A plan can get a rating between 1 and 5 stars:
- 5-stars: Excellent
- 4-stars: Above Average
- 3-stars: Average
- 2-stars: Below Average
- 1-star: Poor
The goal of the ratings is to help you compare plans based on quality and performance. The ratings also support the efforts of CMS to help improve the level of accountability for the care provided by physicians, hospitals, and other providers for the benefit of Medicare beneficiaries.
Ratings for each plan are updated during fall for the following calendar year. Your plan’s rating can change from one year to the next so it is often worthwhile checking if your plan’s star rating has changed to see if you should consider switching.
How are CMS Star Ratings Calculated?
Medicare Advantage Star Ratings
Medicare Advantage plans are given an overall rating based on 5 key categories:
- Member experience: Member ratings of the health plan.
- Member complaints and changes: Focuses on member complaints and changes in the plan’s performance. This includes how often Medicare found problems with the plan, member complaints, and how much the plan’s performance has improved over time.
- Customer service: Quality of call center services as well as how the plan handles member appeals.
- Chronic conditions: Care coordination and how often members with chronic conditions received recommended tests and treatments to manage their condition.
- Staying healthy: If members have access to preventative services such as physical examinations, screening tests, vaccinations, and other check-ups to help them stay healthy.
Medicare Advantage with prescription drug coverage (MA-PD) contracts are rated on up to 44 unique quality and performance measures while MA-only contracts (without prescription drug coverage) are rated on up to 32 measures.
2021 Star Rating: Updates and Impact of COVID-19
For 2021, CMS increased the weight of patient experience/complaints and access measures to reflect CMS’s commitment to serving Medicare beneficiaries by putting patients first, including their assessments of the care received by plans.
CMS has also been monitoring the impact of the Novel Coronavirus (COVID-19) public health emergency on Star Ratings and adopted changes in 2021 to accommodate disruption to data collection posed by COVID-19. These changes eliminate some of the data collection requirements because of the public health and safety concerns with collecting the data. Due to these concerns, CMS eliminated the requirement to submit certain consumer survey data for the 2021 Star Ratings and instead used the data from the prior year for the 2021 Star rating calculations.
Prescription Drug Plan (PDP) Star Ratings
Similar to Medicare Advantage plans, Medicare Part D plans are given an overall rating based on 4 categories and measured on up to 14 different quality measures:
- Member experience
- Member complaints and changes
- Customer service
- Drug safety and accuracy of pricing: How accurate the plan’s pricing information is and how often people with certain medical conditions adhere to recommended drug schedules.
How many 5-star plans are there in 2021?
According to the latest CMS data released in October 2021, quality ratings of Medicare Advantage and Medicare Part D drug plans remain strong. For 2021:
- 9% of beneficiaries in MA-PD plans will be enrolled in plans with 5 stars
- 5% of MA-PD plans available in the market will have an overall rating of 5 stars
- 77% of beneficiaries in MA-PD plans will be enrolled in plans with 4 stars or more in 2021
- 49% of MA-PD plans available in the market will have an overall rating of 4 stars or more
- Average Star Rating for all MA-PD plans improved to 4.06 out of 5 stars in 2021, compared to 4.02 in 2017
- 9% of PDPs available in the market will have an overall rating of 5 stars
- 98% of beneficiaries in a standalone PDP will be enrolled in plans with 3.5 stars or more
How do I enroll in a 5-star plan?
Unlike other Medicare Advantage (MA) or Medicare Prescription Drug (Part D) plans, if a 5-star plan is available in your area, you can enroll in the plan any time of the year using the enrollment periods below:
- Annual Open Enrollment Period (Oct 15 – Dec 7): annually for those already enrolled and switching plans
- Special Enrollment Period (Dec 8 – Nov 30 of next calendar year): You are allowed to switch into a 5-star plan at any time during the Special Enrollment Period, however, you are limited to one usage during this timeframe
If you are enrolling in Medicare for the first time when you become eligible you can enroll in a 5-star plan directly during your Initial Enrollment Period which is the 7-month period that starts 3 months before the month of your 65th birthday.
Star ratings can be an important factor when selecting your Medicare Advantage or Prescription Drug Plan. While star ratings should not be the only factor in selecting your plan, they provide additional points of comparison. You should check your plan’s star rating on an annual basis to see if there have been any significant negative changes. While the vast majority of Medicare beneficiaries will be enrolled in a plan with 4 stars or more, the availability of 5-star plans will depend on where you live.
At CoverRight, we’re here to help you find the right coverage that you deserve. Reach out today and start finding the best Medicare plan for you.