Star Rating with Medicare is a five-star quality rating system for Medicare health plans. In other words, the star ratings are designed to help consumers, their families, and caregivers compare the quality of health plans available in the Medicare program. Plans are rated on a one to five-star scale, with five stars representing the best quality. In this blog post, we will discuss what the Medicare Star Rating System is and how it will change in 2022!
Why Are Medicare Plans Rated?
The Centers for Medicare and Medicaid Services (CMS) rates Medicare plans to help you choose a plan that meets your needs. For Instance, the Star Rating with Medicare is based on data from customer surveys, health care providers, and claims data. Therefore, CMS uses these ratings to identify which plans have the best quality so they can provide incentives to those plans.
How Will the Medicare Star Rating System Change in 2022?
CMS is introducing new measures to the star rating system in 2022. As a result, these changes are designed to make it easier for you to compare plans and choose the best option for your needs. One of the biggest changes is that CMS will now consider patient experience when rating plans. Therefore, plans will be rated based on how well they meet their patients’ needs.
What Does This Mean for You?
If you’re Medicare-eligible, it’s important to understand the Star Rating with Medicare system. The changes in 2022 will make it easier for you to compare plans and find the best option for your needs. However, be sure to talk to your doctor or health care provider about which plan is right for you.
Below is the rating scale so you can understand how they are scaled by Medicare:
- 5-star rating: excellent performance
- 4-star rating: above-average performance
- 3-star rating: average performance
- 2-star rating: below-average performance
- 1-star rating: poor performance
Star Rating with Medicare ratings are released by CMS around early October, just before the Medicare Annual Enrollment Period begins. After that, CMS evaluates and scores three types of Medicare plans each year.
1. Medicare Advantage plans with prescription drug coverage (MA-PD)
2. Medicare Advantage plans without prescription drug coverage (MA only)
3. Standalone Part D prescription drug plans (PDP)
Depending on the type of plan being evaluated, CMS uses anywhere from 12 to 38 quality and performance measures.
What if I am on a 1 Star Plan and find out there is a 5 Star Plan Available?
If you are on a one-star plan and find out that there is a five-star plan available, you can switch to the five-star plan during the Medicare Annual Enrollment Period. This is the time of year when you can make changes to your Medicare coverage. The Annual Enrollment Period for 2022 will be from October 15th to December 7th. However, If you have questions about your coverage or which plan is right for you, be sure to contact your doctor or health care provider. They will be able to help you understand your options and make the best decision for your needs.
Does a 5 Star Plan Get Special Enrollment Periods?
No, the Star Rating with Medicare system does not impact Special Enrollment Periods. However, you may be eligible for a SEP if you move, lose coverage, qualify for Extra Help, or realize there is a 5 Star Plan available. You can learn more about Special Enrollment Periods on Medicare.gov.
Lastly, If you discover that there is a 5 Star Rated Plan. You can use a one-time SEP to switch to this particular plan outside of the Open Enrollment period and Annual Election Period in 2022.
How do I find 5 Star Plans With Medicare Advantage?
This is where you can either go through your medicare and you handbook where these plans would be listed. You can reach out to one of our agents who with a click of their mouse they can look up all the plans and their ratings for 2022. This way we look at the plan the doctor networks and your medications to make sure the plan meets all your needs. Believe it or not, these plans are all zip code-dependent. So having a professional to help will make things a lot less time-consuming.
In conclusion, I hope our blog has helped you understand the rating system and why it exists. It is important to understand how all these things line up. We have a ton of video content that also discusses some of the things covered in this blog. Please reach out if you have any questions.