Medicare Star Ratings are one way the Centers for Medicare and Medicaid Services (CMS) measure. They Measure the quality of care that is being delivered to people with Medicare. The ratings are based on a five-star system. With one star being the lowest rating and five stars being the highest. In this blog post, we will discuss what goes into Medicare Star Ratings. As well as how you can make sure your facility is delivering quality care to its patients.
Medicare Star Rating System:
- 5-star rating: Excellent
- 4-star rating: Above Average
- 3-star rating: Average
- 2-star rating: Below Average
- 1-star rating: Poor
What Do Star Ratings Measure?
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 how many have 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. This includes TTY and interpreter services and processing appeals and new enrollments promptly.
Star Rating For Prescription Drug Plans
For Medicare Part D stand-alone Prescription Drug Plans and Medicare Advantage plans that include drug coverage, Medicare star ratings are also based on the following criteria:
- Member experience
- Member complaints
- Customer service
- Drug safety and drug pricing accuracy
The drug safety score is based on factors such as how accurate the plan’s pricing information is. As well as how often members with certain medical conditions are prescribed drugs. This has to be in a way that is safer and clinically recommended for their condition. Plans are also rated for whether drug pricing information on Medicare Part D Prescription Drug Plan. As well as Medicare Advantage Prescription Drug plan websites is up-to-date and accurate. In addition, the percentage of plan members who got prescriptions for certain drugs. Drugs with a high risk of serious side effects. If there may have been a safer drug choice is also reviewed and scored.
The overall rating gives a quick summary of a plan’s performance. 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.
Keep in mind that plan ratings can change from year to year and are updated every fall. If you are enrolled in a Medicare plan, be sure to check the Medicare star ratings every fall so you can make an informed decision about whether to stay on the plan or switch to a different plan.
Why are Star Ratings Important?
Medicare star ratings are one way to measure the quality of care being delivered by a facility. If you are looking for a new facility or trying to decide whether to stay with your current facility, checking the Medicare star ratings can give you some insight into the quality of care being delivered.
CMS uses star ratings as part of its quality improvement efforts, and as a way to help beneficiaries choose a Medicare plan that best meets their needs. CMS also uses star ratings to determine which plans receive quality-based bonuses (QBB) payments. QBs are extra payments that CMS gives to Medicare Advantage plans that have high overall star ratings or show significant year-over-year improvement in their star
How Do I Find 5-Star Plans in My Area?
The easiest way to find a five-star plan in your area is to use the Plan Finder tool on Medicare.gov. You can search for plans by type, location, and other factors. When you find a plan that interests you, click on the plan name to get more information. One of the pieces of information you will see is the plan’s star rating.
You can also use the Medicare Plan Finder tool to compare plans side-by-side. This can be helpful if you are trying to decide between two or more plans. You can compare up to three plans at a time. To do this, select the “Compare Plans” option on the Plan Finder home page.
When you compare plans, you will see each plan’s star rating as well as other important information such as the monthly premium, deductible, and copayments. You can also see which plans to cover your preferred pharmacies and drugs.
Keep in mind that you can switch plans at any time during the year if you are not happy with your current plan. You can also enroll in a new plan if you become eligible for Medicare (for example, if you turn 65 or lose your job-based health insurance).
If you have any questions about Medicare star ratings or how to find a five-star plan in your area, please contact us. We would be happy to help you.
Thank you for reading! We hope this article was helpful.