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Why Are Star Ratings Important to Medicare Advantage Plans?

what is the medicare star rating graphic

How Star Ratings Can Help You Find the Best Medicare Plan for You

When it comes to your health, it’s understandable that you would expect top of the line care and insurance. In the same way that some health care providers have online reviews and ratings, Medicare Part C (Medicare Advantage) and Part D plans come with their own ratings in the form of a 5-star system.

Each year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. This rating is meant to be a measurement of the quality of health and drug services plan members receive. In turn, those researching their Medicare Part C or Part D options can use these star ratings to help them make the best choice for their personal health care needs.

What Is a 5-Star Medicare Plan?

As mentioned, these ratings are based on a 5-star system, with 5 stars being the most a plan can receive. A 5-star Medicare plan is one that excels in a variety of areas that include quality and performance. That second part is what makes this rating system so helpful, as is it goes beyond looking at plan benefits and analyzes the actual performance of the plan. It’s not just what the insurance plan is promising but also how well it delivers on those promises.

When determining a plan’s star rating, CMS will look at how many members left the plan, how many stayed with the plan and how many complaints were received about the plan. CMS will also look at data from doctors and hospitals that work with the plan, as well as member feedback regarding the plan’s service and care.

The Difference of a 5-Star Plan

A plan with 5 out of 5 stars is considered “Excellent” according to the CMS rating, and of course, the more stars the better. Here are how the ratings break down.

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

So, what do you get for enrolling in a Medicare Advantage or Part D plan that has a high star rating? In addition to the knowledge that you are in a top-rated plan, Medicare enrollees also benefit from the fact that CMS rewards high-rated plans with bonus payments that must be spent on extra member benefits.

Plans that receive a 4-star rating or higher receive these additional bonus payments. You, as a potential member, can benefit from this by taking advantage of some of the additional benefits these plans may have due to this bonus. These benefits could be related to vision, hearing, dental or even fitness. For example, a plan may be able to give you access to fitness centers and classes. The plan may even provide reimbursement options for certain health care services.

5-Star Special Enrollment Period

If you are already enrolled in a Medicare plan, you may receive an additional benefit, which is the ability to switch from your current Medicare plan to one that has a 5-star rating. This is known as a Medicare Special Enrollment Period (SEP).

The SEP begins on December 8 and ends November 30 of the next year. During this period, existing Medicare members may move to a 5-star plan, but they may only do so once during the SEP. You can learn more details about this period and some of its restrictions by visiting the Medicare.gov website.

How to Find 5-Star Medicare Plans in Wisconsin

If you’re wondering what your 5-star Medicare Part C or Part D options are in Wisconsin, you can browse plans by going to Medicare.gov, which allows you to sort plan options based on your personal health needs, star rating, service area and more. We also update our star rating information each year here on the Network Health website.

If you have any questions about Medicare plans, the Star rating system or how to find the best Medicare coverage, contact a Network Health Medicare plan expert today. We would be happy to guide you through your options and help you enroll when you’re ready.

CALL 844-466-2400 (TTY 800-947-3529)

 

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