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Why are Medicare Star Ratings Important?


Medicare star ratings are important because they give you an idea about which plans in your area have the highest satisfaction ratings. Star ratings only pertain to Medicare Advantage and Part D plans. For both types of coverage, the ratings provide a way to compare your plan options beyond their cost.

What are Medicare Star Ratings?

The Centers for Medicare Medicaid Services (CMS) developed a five-star rating system for beneficiaries to compare Medicare Advantage and Medicare prescription drugs plans. Medicare reviews the plans’ performances each year.

The five-star quality rating system measures the experiences of beneficiaries on each plan. Plans will receive a rating between one and five stars.

  • 5-star: Excellent
  • 4-star: Above Average
  • 3-star: Average
  • 2-star: Below Average
  • 1-star: Poor

However, newer plans are more difficult to rate since they may not have enough feedback from beneficiaries.

What Are Star Ratings for Medicare Plans?

The star rating system helps consumers identify the best Advantage plans. If a plan is low-performing for several years, you have the right to know.

Medicare considers the plan below average if it gets a rating of fewer than three stars for three years in a row. Also, the ratings make it easier to identify the best Part D plans.

How are Medicare Star Ratings Calculated?

Medicare will calculate Part C star ratings in five different categories. These categories are: staying healthy (preventive services), plan responsiveness, managing chronic conditions, customer service, and management of member complaints.

For Part D plans, there are four different categories for ratings: customer service, member experience, drug pricing, and member complaints.

What is the Five-Star Special Election Period?

If a plan in your area has five stars, you get a Special Election Period to enroll in that plan. Therefore, if you want to enroll in a five-star Medicare Advantage plan or a Part D plan, you have to sign up between December 8 and November 30 of the following year.

You can only sign up once a year. If you decide to leave the plan, you will need to wait for the fall Annual Enrollment Period.

How Do You Become Eligible for Five-Star Plans?

As long as you have Part A and Part B, you’re eligible for a five-star Advantage plan. But, to be eligible for a Part D plan, you need either Part A or Part B. Also, you must reside in the service area for the plan to enroll.

Some Medicare Advantage plans used to deny coverage to those with ESRD, until the rules changed in 2021.

FAQs

Who sets the standards for Medicare star ratings?
The Center for Medicare and Medicaid Services (CMS) sets the ratings for plans.
When Does CMS issue star ratings?
The ratings for Part C and Part D plans are released each fall.
Where can I find information on my plan’s star rating?
You can view star ratings on Medicare’s website, Medicare.gov.

How to Compare Plans Using the Medicare Star Rating System

When you look at your plan options online, you’ll notice ratings for each policy. Plans with higher ratings are policies that work well for past and current beneficiaries. Also, if you’re on the fence about two plans, seeing the score helps you determine the final choice.

Now, keep in mind all Medigap plans would get five stars. Most providers accept Medicare Supplement plans, so they simplify your health care coverage.

If you’re having a hard time finding quality coverage, give us a call at the number above to get an expert opinion on your options. You can also fill out an online rate form to see your rates now!

Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

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