Medicare uses star ratings to help people compare the quality of health and drug plans. The Centers for Medicare & Medicaid Services (CMS) base the ratings on specific measurements and update them each fall.
This article looks at Medicare and the program’s star ratings system. It also explains how to evaluate health and drug prescription plans using the star rating system and describes the five-star special enrollment period.
Federally funded Medicare is a health insurance program for people aged 65 years or older and for some younger people with certain disabilities.
The program comprises four parts:
- Part A is hospital insurance.
- Part B provides medical insurance.
- Part C, also known as Medicare Advantage, offers an alternative option to original Medicare (Part A and Part B).
- Part D covers prescription drugs.
Medicare’s five-star quality rating system shows a plan’s performance ratings and is designed to help a person easily compare health plans. The rating system applies to Medicare Part C plans and Part D plans.
The performance ratings are based on the details of the plan and information from various sources, including healthcare providers and member satisfaction surveys. The rating scale is between one and five stars, with a five-star rating representing an excellent plan and a one-star rating suggesting a poor one.
The ratings can change each year, and the CMS release updates in the fall for the following year.
Concerns about possible issues around data collection during the COVID-19 outbreak led the CMS to use some information from the previous year. These data included the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data and the Healthcare Effectiveness Data and Information Set (HEDIS).
Only Medicare Part C plans and Part D plans get star ratings. The star rating system tells a person how well each plan performs. Plans get a rating in several categories before the CMS assign them an overall star rating.
The 2021 star ratings are based on the following:
- The rating of Advantage plans with prescription drug coverage takes into account 44 performance and quality factors across five categories.
- A total of 32 measurements in five categories contribute to the ratings of Advantage plans without prescription coverage.
- The CMS consider 14 factors in four categories to rate Part D prescription drug plans.
Medicare Advantage
The performance of Medicare Advantage plans in five categories contributes to their score:
- tests, screenings, and vaccines
- responsiveness and care
- managing chronic conditions
- complaints, problems, and people leaving the plan
- customer service
Learn more about Medicare Advantage plans here.
Plan D
The rating of Part D plans involves four categories:
- customer service
- complaints, problems, and people leaving the plan
- member experience
- accurate pricing and patient safety
A person can check a plan’s star rating using this online tool or by calling 1-800-MEDICARE.
According to the CMS, almost half of all Medicare Advantage plans that include prescription drug coverage have an overall rating of four stars or higher for 2021.
Further information from the CMS shows that more than 76% of stand-alone Part D plans carry a star rating of 3.5 or higher for 2021.
Both the five-star Advantage plan and stand-alone Part D drug plans have a special enrollment period (SEP). During the SEP, a person can switch from their current Medicare plan to a plan with a five-star rating.
The SEP enrollment period runs from December 8 to November 30.
A person who switches from an Advantage plan with drug coverage to a five-star plan without drug coverage will lose their prescription drug benefit. They may have to wait until the next open enrollment to get drug coverage and may have to pay a Part D late enrollment penalty.
If a person chooses to switch from an Advantage plan to a five-star Part D drug prescription plan, they will lose the Medicare Advantage coverage, and Medicare will automatically enroll them in original Medicare (Parts A and B). They can enroll in a Medicare Advantage plan again during open enrollment.
Medicare uses a five-star rating system to help people compare plans. The ratings are based on customer satisfaction and a review of records.
The system uses five categories to rate Advantage plans and four categories to rate Part D plans. People can find the star ratings for the plans available in their area using the Medicare plan finder online tool.
Medicare has a special five-star rating open enrollment period from December 8 to November 30 each year, during which a person can switch from their Advantage plan to a five-star plan.