I’m choosing a Medicare Advantage plan for next year. What is the significance of the Medicare Advantage star ratings, and how can I use them to pick a plan during open-enrollment period?
This year, open enrollment runs from October 15 to December 7, so now is the time to begin doing your research -- and Medicare Advantage star ratings are a key factor in choosing a plan. The ratings assess Medicare Advantage plans on 50 measures in five categories, focusing primarily on each plan’s coverage, the effectiveness of its communications and its customer service. The highest rating is five stars.
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The first category gauges the plan’s effectiveness in keeping people healthy, including its wellness coverage and the percentage of patients who receive screenings, tests and vaccines. The other categories measure how the plan treats chronic conditions; how quickly patients can get appointments and see specialists; how responsive the plan is to complaints; and how it handles appeals, enrollment requests and other customer-service issues. For more information about the criteria for the quality ratings, see Choose Higher Quality for Better Health Care. You can get more information about a plan’s ratings and see how it performs in each category at the plan’s page in the Medicare Plan Finder (Medicare Advantage plans are called “Medicare Health Plans” in the Plan Finder).
In general, the plans are getting better. According to a recent announcement by the Centers for Medicare and Medicaid Services, 127 Medicare Advantage plans received a four-star or five-star rating for 2013, up from 106 plans in 2012. Still, only 15 Medicare Advantage plans received a five-star rating in 2013, up from 12 in 2012. These plans are marked with a gold-star icon in the Medicare Plan Finder. You can switch to a five-star plan anytime during the year, not just during open-enrollment season, but you have to live in one of the relatively few areas where a five-star plan is available: certain counties of California, Colorado, Hawaii, Iowa, Maryland, Massachusetts, Minnesota, Ohio, Virginia, Washington State and Wisconsin as well as Washington, D.C.
Along with making it easier to sign up for a five-star plan, the Centers for Medicare and Medicaid Services is trying to discourage people from signing up for low-performing plans. If you are currently in a plan that has received fewer than three stars for at least the past three years, you will receive a letter during the last week in October pointing out the plan’s low rating and reminding you that you have the opportunity to switch to another plan during open enrollment. Only ten Medicare Advantage plans received the low-performing rating for the past three years. For more information, see the Medicare Plan Finder.
A plan’s quality rating isn’t the only consideration. Also focus on the plan’s cost and coverage. Check out the plan’s premiums plus co-payments for your drugs and the medical expenses you typically have, as well as the plan’s out-of-pocket maximums (the most you’d have to pay for premiums, deductibles and co-payments over the year). And make sure the plan covers the doctors, hospitals, pharmacies and other providers you typically use. Many plans have been shrinking the size of their networks, so you can’t assume the providers you used in the past are still on the in-network list.
For more information about all of the factors to consider when choosing a Medicare Advantage or Medicare Part D plan for 2013, see Sift Through Your Medicare Choices and What to Know About 2012 Medicare Open Enrollment.
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