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What Are Medicare Plan Star Ratings and Why Do They Matter?

When it comes to Medicare coverage through Medicare Advantage and Part D plans, kupuna have more quality options than ever. While it is certainly nice to have lots of options to choose from, it can be overwhelming to narrow the list down to the right plan for your health needs and budget. That’s where the Medicare Plan Star Rating System comes into play. The Star Rating System uses a list of categories to score how well each plan performs – both for individual categories and the plan overall. The scores go from one (lowest) to five (highest). When you are starting your search, it probably makes sense to use each plan’s overall star rating to compare them against other plans but as you narrow down your list, you may want to look at a plan’s ratings in each category to determine the best fit. If Medicare assigns a rating of less than three stars for three years in a row, Plan Finder will flag the plan as low-performing with an upside-down red triangle with an exclamation point inside of it.

What you need to know about the Medicare Star Rating System

In January, plans are allowed to change their coverage and costs for the new calendar year, which means that a plan’s performance can change from year-to-year. As a result, Medicare reviews the performance of each plan annually and then releases a new star rating in the fall in time for the Annual Enrollment Period (AEP). We can’t stress enough how important it is to review your plan’s costs and coverage each fall. Your plan will mail you an Annual Notice of Change (ANOC), which is a document that lays out any changes in plan coverage, service area, or costs that will go into effect the following January. Make sure the plan will continue to meet your needs. If any of the planned changes mean that the plan will no longer be ideal for you, the Medicare Star Rating system can be a good place to start comparing plans.

What categories are rated in the Medicare Star Rating System?

Medicare ranks each Medicare Advantage Plan on how well it performs in each of five different categories:

1. How well the plan helps seniors stay healthy through screenings, tests, and vaccines.

2. How well the plan helps members manage chronic illnesses.

3. Plan responsiveness and care.

4. Member complaints, problems accessing services and members choosing to leave the plan.

5. Customer service.

Medicare ranks each Part D plan on how well it performs in each of four different categories:

1. Drug pricing and patient safety.

2. Member experience with the drug plan.

3. Member complaints, problems accessing services and members choosing to leave the plan.

4. Customer service.

Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.

At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.

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