Is your health insurance through a Medicare Advantage plan? If yes, you should know that such plans are now being evaluated annually by the U.S. government. And the new ratings were released last week, to dovetail with Medicare’s New Enrollment period, which runs from Oct. 15 to Dec. 7 each year.
The ratings are issued by CMS (The Centers for Medicare and Medicaid Services), and they are based on a wide range of criteria, including how often members get various screening tests, pro-active management of chronic conditions, drug pricing/safety, member satisfaction and customer service.
The ratings are as follows: 5 stars – excellent; 4 stars – above average; 3 stars – average; 2 stars – below average; and 1 star – poor. The ratings show up as you work your way through the Medicare website’s plan finder. Five-star plans get a gold star, while 1-star plans merit an exclamation point.
The 5-star advantage. Some 14 million Americans are currently enrolled in Medicare Advantage plans, and CMS is attempting to get such plans to improve their quality of care. Plans that CMS rates as five-star are allowed to enroll new members year-round (as long as the new member is leaving a plan rated 4.5 stars or lower), and they also get bonus Medicare payments.
Martindale.com recently reported that only 9% of Medicare Advantage plans rated by CMS get five stars, although this is likely to grow. Consider that almost half of the plans (43%) now get four stars, up from just 23% last year. This improvement indicates that many plan sponsors are implementing changes to improve their scores.
What This Means for You
Just because a Medicare Advantage plan has a five-star rating, do NOT assume it’s your best option. In fact, since few plans are rated five-star now, the five-star plans offered in your area may not include the doctors and clinics you prefer to use.
For example. We used a Seattle zip code on Medicare’s plan finder to search for Medicare Advantage plans with drug coverage. The only 5-star plans that popped up are four HMO plans offered by Group Health.
Just below in terms of ratings – at 4.5 stars — were two Humana Choice PPOs (Preferred Provider Organizations), also with drug coverage.
What was not included on the list was the Kaiser Foundation Health Plan of the Northwest, offered in Oregon and some counties in Washington. This is also a highly rated HMO (#3 nationally according to the ratings by NCQA, a non-profit that rates health insurance plans). But this Kaiser HMO is now available only to those living in the southwest corner of WA State, including Clark and Cowlitz counties.
Comparison shopping. Even if you’re satisfied with your current Medicare Advantage plan, you should still look at what other plans have to offer, at least every couple of years; the premiums and benefits can change annually. Also, your prescriptions might have changed in the past year and not be on the “formulary,” or the list of drugs currently covered by your plan.
For more on this topic, see Health Insurance Is Changing by LNWM’s Kristi Mathisen.