Medicare Advantage plans provide an alternative to Original Medicare. These plans include Medicare Parts A and B, and some also include prescription drug coverage (Medicare Part D).
Seniors who plan to enroll in Medicare Advantage or transition to a new Medicare Advantage should consider using Medicare Star Ratings to help guide their decisions. These ratings are published ahead of open enrollment and are intended to facilitate comparison of programs.
What is a Medicare Star Rating?
Medicare Star Ratings is a ratings system developed in the United States. Centers for Medicare and Medicaid Services. These assessments are designed to help older adults planning to enroll in a Medicare Advantage plan for the first time or planning to transition to a new Medicare Advantage plan evaluate their options. Medicare star ratings also apply to Medicare Part D prescription drug plans.
The Medicare star rating system uses a scale of one to five. A one-star rating represents the lowest possible score, while a five-star rating represents the highest possible score. Assessments are released annually prior to the fall Medicare open enrollment period, October 15-December 7, 2022.
What is the 5 Star Special Registration Period?
If you want to switch from your current Medicare plan to one with a 5-star rating, you can use the Medicare Special Enrollment Period (SEP) to join or switch to an eligible plan – called Medicare Advantage, Medicare Cost, or Medicare Part D prescription drugs Planning — right next to you.This special 5-star registration period starts on December 8th and runs until November 30th.
- Registration for December is valid from January 1st
- Sign up from January to November, and the registration will take effect the next month
- You can only use this SEP once between December 8th and November 30th
How do Medicare star ratings work?
Medicare star ratings are based on up to 38 unique quality and performance indicators. Ratings apply to Medicare Advantage plans and Medicare Part D prescription drug plans. The review will consider the following factors:
- customer service
- Complaints about the program
- Member experience
- How many people choose to leave the program
- Provide annual screening and prevention services
- Get an Appointment Speed
- chronic disease management
- Drug safety and drug price accuracy
The review does not take into account the costs of the plan itself, including premiums, coinsurance and co-pays. Instead, Medicare star ratings are designed to measure overall satisfaction with a particular plan and the level of coverage, service and support provided.
How to Use Medicare STAR
Medicare star ratings are intended as a guide to Medicare plans, and you can view the ratings by logging into your Medicare account. If you don’t have a Medicare account because you’re enrolling for the first time, you can still search for plans on the Medicare website by zip code.
You will be asked if you receive Medicaid health care assistance, Supplemental Security Income (SSI), Medicare Savings Plan, or Extra Help from Social Security. You can answer “I don’t know” if you are not sure, or “No” if you have not received such assistance. You also have the option to enter information about any prescription drugs you are currently taking.
After entering these details, you’ll see a list of available programs in your area, ranked by star rating. The highest rated plans are at the top. At this point, you can review information for each plan, including:
- Monthly bonus
- Copayments and coinsurance
- Plan benefits
- Drug coverage
You can compare plans to see how they stack up. However, it’s important to remember that Medicare star rating isn’t the only factor to consider when choosing a plan.
It is also important to consider your individual needs, preferred health care provider, and budget when choosing a Medicare Advantage plan. For example, when considering whether to join a Medicare Health Maintenance Organization (HMO) or Medicare Preferred Provider Organization (PPO), you may want to ask the following questions:
- Which doctors can I see?
- Do I have to choose a family doctor?
- Do I need a referral to see a specialist?
- What happens if I go out of the network for treatment? What do I need to pay?
You may wish to revisit these questions each year to ensure your current plans are still appropriate. The fall Medicare open enrollment period begins in October and runs through December, but the second open enrollment period for Medicare Advantage plans runs from January 1 to March 31. Planning ahead can help you make a more informed decision about whether to keep your current plan or switch to a new one
When are Medicare star ratings updated?
Each fall, CMS publishes star ratings for the upcoming program year. For example, a program review for 2022 will be available in October 2021. Star ratings are calculated annually and may change from one year to the next.
If you are enrolled in a Medicare plan, you should check your plan’s star rating each fall. You can then make an informed decision whether to keep the plan or move to a higher-rated plan.