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Medicare Star Ratings: What Are They and How Can They Affect Plans?

Each year CMS (Centers for Medicare and Medicaid) measures Medicare Advantage Plans (Part C) and Part D Prescription Drug (PDP) plans to see how well they are performing. The grade each plan receives is based on a range from 1 to 5 stars, with 5 being the highest a plan can receive, and one being the lowest. Medicare scores how well the plans do in several categories and the plan is assigned one Star Rating to summarize the plan’s overall performance, as well as separate Star Ratings in each of the individual categories reviewed. Here’s how:

The overall Star Rating of a plan provides a way to help beneficiaries compare the performance of several plans.

Medicare reviews the plans each year which means a plan’s rating can change from one year to the next. New Star Ratings are released every Fall. Medicare sets the categories and reviews each plan the same way.

When CMS is reviewing a plan they rate them on how well they perform in 5 different categories:

  1. Screenings, testing and vaccines
  2. Managing chronic conditions (long term conditions)
  3. Member complaints, issues with receiving services, and beneficiaries choosing to leave the plan
  4. Plan responsiveness and care
  5. Customer service

Medicare Part D drug plans are rated by how well they perform in 4 different categories:

  1. Customer Service
  2. Member complaints, issues receiving services, and beneficiaries choosing to leave the plan
  3. Member experience with the drug plan
  4. Drug pricing and patient safety

A plan’s star rating is something to consider when you are comparing plans that are available to you in your area, however, even though a plan has a high star rating it does not mean it is the right plan for you.

You will also need to take into consideration:

  • Costs associated with the plan
  • What it covers, including prescriptions you may require
  • If your preferred doctor, clinic, specialists, hospital and pharmacy are within the plan’s network.

If you would like more assistance on finding plans that have a five star rating, give one of our licensed agents a call. We’re happy to help!  

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