When it comes to Medicare Advantage plans or Medicare Prescription Drug plans, CMS (The Centers for Medicare and Medicaid) use a five star rating to measure Medicare beneficiaries experience with the plan that he or she has.
When presenting either a Medicare Advantage plan or a Medicare Prescription Drug plan to a client, it is a requirement set by CMS to make sure the client understands the rating of the plan.
To help you understand how these ratings are calculated, I thought it would be helpful to share how the star ratings are derived.
A Medicare Advantage plan is rated based on these five different catergories:
- Staying healthy: screenings, tests, and vaccinations
- Managing long term or chronic illnesses such as diabetes, asthma, or COPD
- The member’s experience with the plan
- The member’s complaints and changes in the health plan’s performance
- The Health Plan’s customer experience
A Medicare Prescription Drug plan is rated based on these four different catergories:
- Drug plan customer service
- The member’s complaints and changes in the drug plan’s performance
- The member’s experience with the drug plan
- Patient safety and accuracy of drug pricing
In addition, CMS looks at how the plan benefits members by improving relationships with their physicians with greater focus on preventative service for early detection. Early detection helps keep costs down for both members and the insurance companies.
CMS uses information from customer surveys, plans, and health care providers to give an overall star rating performance. Plans can get anywhere from one to five stars with five being considered excellent. These ratings can help you as a consumer compare and base your decisions on what plan you choose for your health or prescription drug plan needs.
CMS updates these five star ratings every fall for the following year. New plans aren’t rated until they have been in existence for at least a year of data.
All of this is important because it does help you to look at the performance and quality of the plan. It is also important because if a plan reaches a five star rating, you can switch either your Medicare Advantage or Medicare Prescription Drug plan to a five star plan if one is available in your area.
You can switch to these plans once during the time frame of December 8 – November 30th.
If you want more information on Medicare, Medicare Advantage, Medicare Prescription Drug plans and how they are rated, give Balanced Care a call.
Your health is your most valuable asset. Take care of it by knowing all you need to know about the plans you are purchasing to protect it.
Terri Trepanier is the owner of Balanced Care Health and Supplemental Insurance and a licensed insurance consultant and broker with Associated Brokers. Licensed in both Maine and NH, her specialty is working with small businesses, individuals, and families with their health and life insurance needs. She is certified to offer health plans both on and off the exchange and is contracted with every health insurance company that offers plans in both New Hampshire and Maine. Her other passion is assisting Medicare beneficiaries with their Medicare Supplemental, Medicare Part D Prescription Drug Plans, and Medicare Advantage plans. Terri has seen firsthand the importance of insurance products and how they help families. Her goal with Balanced Care is to “Insure Security and Peace of Mind One Family at a Time”.