5 Things to Know About Medicare Advantage Plan Ratings

The Medicare Star Ratings were established to help evaluate Medicare Advantage plans and Medicare Part D prescription drug plans based on their performance in a number of areas.1

All Medicare Advantage plans are scored on a star system ranging from one to five stars. A one-star plan is a poor performing plan, while a five-star Medicare Advantage plan is considered excellent.

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Here are five things to know about Medicare Advantage plan ratings.

1. Medicare Star Ratings are decided by the CMS

Medicare Advantage plans are rated by the Centers for Medicare & Medicaid Services (CMS) every year. The ratings are released in the fall, reflecting the ratings for the upcoming year.

The Medicare Star Rating breakdown is as follows:

Medicare Star Ratings

★★★★★

Excellent

★★★★

Above Average

★★★

Average

★★

Below Average

Poor

2. Star Ratings are based on five plan aspects.

  • Screening tests and vaccines
    What kind of access do plan members have to preventive services, like annual physicals and screenings?

  • Management of chronic conditions
    For members with chronic conditions, how efficiently was their care coordinated, and how often did they receive treatment for long-term health conditions?  

  • Member experience with the plan
    How was a member’s overall satisfaction with the plan?   

  • Member complaints and changes in plan performance
    How often did plan members issue complaints about the plan, have problems receiving covered services or opt out of the plan? And did the plan’s performance improve from the previous year?

  • Customer service
    What was the quality of service at the plan’s call center. and how efficiently were appeals and enrollments processed?

In addition to receiving an overall star rating, each Medicare Advantage plan is given a rating of one to five stars for each of the five individual categories above.

3. Low-performing plans may be flagged.

If a plan earns fewer than three stars for three consecutive years, it will be flagged by the CMS as an underperforming plan.

All members of the plan will receive a notice and be given an opportunity to enroll in a different plan that is rated three stars or better, or a new plan that does not yet have a rating.

4. There is a Special Enrollment Period for five-star Medicare Advantage plans.

For 51 weeks a year, anyone enrolled in a Medicare Advantage plan that has a rating of fewer than five stars may switch to a plan with a five-star rating. This is called the Medicare Five-Star Special Enrollment Period, and it runs annually from Dec. 8 to Nov. 30 of the following year.

During this time, you may disenroll from your current plan and sign up for a plan with a five-star rating.

5. It’s easy to find a plan’s Star Rating.

To find out the rating of any Medicare Advantage plans sold in your area, contact a licensed insurance agent by calling TTY Users: 711 24 hours a day 7 days a week.

In addition to reviewing Medicare Advantage plan ratings with you, an agent guide you through the enrollment process once you find the best plan for your needs.

 

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1 Every year, Medicare evaluates plans based on a 5-star rating system.

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MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.