CMS rates the performance of Part C (Medicare Advantage) and Part D (Prescription Drug) plans on a 1-5 star scale (5 being the highest). This is an important criteria to consider while selecting your plans, apart from factors such as cost, coverage and accessibility.

In order to keep on improving the quality of healthcare and customer experience, Medicare uses a Star Rating system to measure how well Medicare Advantage (MA) and Prescription Drug (PDP) plans are performing. These plans are rated every year as Medicare tries to continuously enhance the level of quality care and accountability provided by different players.

As a user, the star rating system provides you with an opportunity to compare performance among several plans to make the right choice.

The plans are rated on performance as follows:

• 5 stars – Excellent
• 4 stars – Above average
• 3 stars – Average
• 2 stars – Below average
• 1 star – Poor

Criteria used for Star Rating

Medicare health plans are rated based on performance in five different categories, while Medicare Part D stand-alone prescription drug plans and Medicare Advantage plans that include drug coverage are rated on performance in four categories.

Health plan rating parameters

• Staying healthy: Access to services such as screenings, tests, vaccines, etc. to stay healthy
• Managing chronic conditions:  How often members got recommended for tests and treatments to help manage their condition
• Plan responsiveness and care
• Member complaints: Problems in getting services, and those choosing to leave the plan 
• Customer service: Communication-related and processing of enrollments and appeals.

Drug plan rating parameters

• Customer service: Handling appeals and customer communication
• Member complaints: Problems in getting services, and those choosing to leave the plan
• Member experience: Includes ratings of the plan
• Drug pricing and patient safety: Includes how often members are prescribed drugs that are safer and clinically recommended for their condition and also pricing of drugs.

Caution

Just because a plan has a 5-star or 4-star rating, it does not necessarily mean that it is the right plan for you. It is important that you also consider aspects such as cost of the plan, whether it covers all the drugs and services you may need and your proximity to providers in its preferred network.

Click here to learn more about Medicare, its various Parts, different enrollment periods and your costs. 

We have also created videos to help you better understand various topics related to Medicare. Select and watch a video explaining the topic of your interest in a simple and intuitive manner.

Remember that you cannot choose just any combination of Parts and Plans. Let Lighted Road Insurance guide you step-by-step through the Medicare ecosystem and help you in selecting the right plan(s) for your needs.