The Centers for Medicare & Medicaid Services (CMS) created a Star Rating system to help beneficiaries and their families compare plan performance and quality for Medicare Advantage plans, Medicare Prescription Drug Plans, and Medicare Cost plans.
Medicare plans are rated on a scale of 1 to 5, with a 5-star rating being the highest score a plan can receive. More stars indicate better performance and quality:
5 Star Rating: Excellent
4 Star Rating: Above Average
3 Star Rating: Average
2 Star Rating: Below Average
1 Star Rating: Poor
For Medicare plans providing health coverage, such as Medicare Advantage or Medicare Cost plans, each plan is given an overall summary rating based on how it performs across five main categories:
Staying healthy: Plans are rated on whether members had access to preventive services to keep them healthy. This includes physical examinations, vaccinations like flu shots, and preventive screenings.
Chronic conditions management: Plans are rated for care coordination and how frequently members received services for long-term health conditions.
Member experience: Plans are rated for overall satisfaction with the health plan.
Member complaints: Plans are rated on how frequently members submitted complaints or left the plan, whether members had issues getting needed services, and whether plan performance improved from one year to the next.
Customer service: Plans are rated for quality of call center services (including TTY and interpreter services) and processing appeals and new enrollments in a timely manner.
The overall rating gives a quick summary of a plan’s performance, but you can also look up how the plan scored for individual areas within the above main categories. For more information on the criteria Medicare considers when rating its plans, visit Medicare.gov.
So Who Made the Cut for 2019 in Tampa Bay
The 5 Star Rating from Medicare is not given out freely. In fact, only 4 Medicare Advantage plans of the 34 available in Tampa Bay received the designation.
BlueMedicare Classic H1035-021
BlueMedicare Classic Plus H1035-023
CareOne PLUS H1019-054
Multiple plans lost the 5 Star Rating from 2018 to 2019 in Tampa Bay, including the Freedom and Optimum plans that had received the high marks last year. While a 5 Star Rating is not the only indication of a satisfactory health plan and should not be your only consideration when deciding which plans might be best for you, it is a good indicator of the experience of previous and current members insured in the plan had. As plan performance changes from year-to-year, it would be prudent to review your coverage and plan during every annual enrollment period. How did your plan stack up from last year?