MEDICARE STAR RATINGS

The Centers for Medicare & Medicaid Services (CMS) uses a five-star quality rating system to measure Medicare beneficiaries' experience with their health plans and the health care system. ... The program is a key component in financing health care benefits for Medicare Advantage & PART D plan enrollees.  Medicare scores how well plans perform in several categories, including quality of care and customer service. Ratings range from one to five stars, with five being the highest and one being the lowest.

WHY are they SO IMPORTANT

These ratings are also important because CMS has created a Special Election Period (SEP) that allows Medicare beneficiaries to enroll in 5-star Medicare Advantage plans at any point during the year. Plans with higher star ratings are typically more consistent and stable with fewer changes. This can be seen in areas such as copays and annual maximum out of pocket costs where these dollar amounts remain stable or even lowered. You can also see it in the provider offering where fewer disruptions with doctors or facilities dropping out of the network takes place.  

WHO USES THE STAR SYSTEM

Several leading healthcare technology consultants have reported that in recent surveys only 22% of beneficiaries use the ratings to select their plan.  That's one in five. For clients who lean more towards the Medicare Advantage plans, we lead this process by explaining the Star Rating System and how a plan with a high star rating system benefits the care they receive & how much they may pay for services.

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