Star Ratings and Why They Are Important

September 3, 2018 | Debby Jesser

When choosing a Medicare plan, one important attribute to consider is a “Star Rating.” The overall Star Rating gives a ranking of the Medicare plan’s quality and performance for the types of services that each plan offers.

What You Need to Know About Star Ratings

Plans rank from 1 to 5 stars (with 5 stars being the highest). You can verify a rating through Medicare or by contacting the plan directly.

If a plan receives lower than 3 stars for three years in row it will be flagged as a “Low Preforming” plan.  Medicare will notify you if you are enrolled in a “low preforming” plan.  You will not be automatically removed from the plan, but we could assist you with finding higher performing plan options.

When you see this symbol  near a­ plan name, it means that Medicare has given the plan a 5-star rating (the highest rating). If a plan has a 5-star rating, people with Medicare can switch into that plan at any time during the year, even if it’s not during an enrollment period.

Rating Categories for Health Service Plans

Managing Chronic Conditions: Rates how often members with specific conditions receive tests and treatments.

Screening Tests and Vaccines: Rates whether members get vaccines and screening tests.

Health Plan Member Experience:  This is the member rates (opinions) of their specific plan.

Member Complaints: Tests how often Medicare found problems with the plan, how often members had problems with the plan, and how much (if any) of the plan’s performance has improved. 

Health Plan Customer Service: Measures how well the plan handles the member appeals.

Rating Categories for Prescription Service Plans

Drug Plan Customer Service: Measures how well the plan handles member appeals.

Member Complaints: Includes how often Medicare found problems with the plan and how often members had problems with the plan. Includes how much the plan’s performance has improved (if at all) over time.

Member Experience with Plan’s Drug Services: Includes member ratings of the plan.

Drug Safety and Accuracy of Drug Pricing: Measures how accurate the plan’s pricing information is and how often members with certain medical conditions are prescribed drugs in a way that is clinically recommended for their condition.   

Medicare put together a comprehensive chart that gives more in-depth details about other star ratings, such as the ease of getting needed care, getting appointments quickly, and more. Do you need help with deciding which start plan is best for your specific needs? Our team is here to help!