What is the Star Rating System for Medicare Plans?

When you’re turning 65 and become eligible to participate in Medicare, it can be challenging to identify the set of benefits to select to meet your exact needs. And if you’re already a Medicare beneficiary, reevaluating your coverage based on changing circumstances, it can be difficult to choose the Medicare plan that offers the most benefit.

Fortunately, the Medicare Star Rating System can help you select the Medicare plan that’s right for you. Let’s identify what this system is, how it works and how you can use Star Ratings to determine your choice of Medicare coverage. Here’s everything you need to know about the Star Rating System for Medicare Plans.

What is the Star Rating System for Medicare Plans?

In the simplest terms, the Star Rating System determines the quality of Medicare Advantage plans and Part D prescription drug coverage plans, measuring them against several different factors of performance. Everything from the quality of medical care received to the availability of excellent customer service communications factors into the overall rating that a plan receives. Understanding the role of the Star Rating System for Medicare Plans is one of the best ways to ensure that you obtain the plan and coverage that fits your needs. Plans rank anywhere from one star (lowest quality) to five stars (highest quality). Using this simple measurement, you can begin to see how your top plan choices stack up against other Medicare Advantage and Part D plans.

How to Use the Star Rating System to Analyze and Choose the Best Medicare Advantage and Part D Plans

First and foremost, since Medicare plan coverage and costs change regularly, plan performance is reevaluated on a yearly basis. This means plan star ratings may change each year, with the results being released to the public each October and go into effect the following year. Medicare recipients can rely on newly released star ratings to inform their decision to change existing coverage or enroll in a new plan during the Annual Enrollment Period, which begins October 15th and lasts until December 7th. After evaluating Medicare plan options and costs, coverage and prescription inclusions and the practices available in each network, the Star Rating System can help you finalize your choice of coverage.

Medicare Advantage Plan Performance Factors that Determine Star Ratings

There are five key categories that factor into a Medicare Advantage Plan’s Star Rating. The first category is what’s known as Staying Healthy. This category covers issues such as a plan’s ability to provide access to tests, health screenings, physical exams and other preventative health measures. Next up, the second ranking factor is Managing Chronic Long Term Conditions. Did you know that people under the age of 65 who receive Social Security Disability Insurance (SSDI) payments generally become eligible for Medicare after a two-year waiting period? Those diagnosed with end-stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS) become eligible for Medicare with no waiting period. For these reasons, it’s important to understand how long-term conditions are handled by a plan. This category relates to how well a plan is able to provide a patient with management and treatment options for long-term conditions. The third category is Member Experience. This consideration takes into account the overall experience and patient satisfaction with their plan and the ease of obtaining service and the quality of care received. The fourth category in the Star Rating System for Medicare Advantage Plans is called Member Complaints. This category tracks the number of complaints from members and ranks the plan’s ability to deal with them in a professional, helpful manner. The fifth and final category used to rank Medicare plans is Customer Service. This category rates the plan’s response to customers, including handling disputes and getting new enrollments underway.

Medicare Part D Performance Rankings Measurement Scale

Medicare Part D Plans (stand-alone prescription drug coverage) are ranked based on different rankings factors. Though if the Medicare Advantage plan in question includes prescription drug coverage, it is evaluated on these criteria as well.

These ranking factors include: member experience and one’s satisfaction with the drug plan, the handling and responsiveness toward member complaints, customer service and ease of obtaining service and lastly, patient safety and the accuracy of prescription drug pricing.

Need Help Choosing the Right Medicare Plan? A Medicare Insurance Agent Near You Can Provide Assistance

As we’ve discussed, the Medicare Star Rating System provides important considerations to take into account before selecting a Medicare plan. The number of coverage options can seem overwhelming, but this system can help narrow down your options and identify each plan’s patient care and service quality ratings. Whether you’re nearing eligibility for Medicare coverage or are a current recipient and need to choose a different plan, it’s important to be satisfied with your Medicare coverage, benefits and costs.

Our experienced, licensed agents at Medicare Portal can help guide you toward selecting the plan best suited for you and providing you with all the resources you need to make an informed decision. Learning how to use the Star Rating System for Medicare Plans is one of the first steps toward selecting a plan, and we can help you guide you the rest of the way through Medicare eligibility and enrollment. Whether you’re confused about your eligibility for Medicare, need assistance determining your enrollment period, how to select Medicare supplements or any other coverage issue, you don’t have to go it alone. At Medicare Portal, our local Medicare insurance agents are available over the phone, online or in person to provide more information and assistance.

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