Why Am I Seeing Stars?

Why Am I Seeing Stars?

When you are looking at purchasing a Medicare Advantage Plan or Drug Plan you see something called a Star Rating, but what does that even mean? Medicare Advantage with prescription drug coverage benefits are rated on up to 44 unique quality and performance measures, MA only plans (plans without the prescription drug benefit) are rated on 33 measures and standalone drug plans are rated on up to 13 measures.

CMS every year conducts a comprehensive review of the measures that make up the Star Ratings. They consider the reliability of the measures, clinical recommendations, feedback received from stakeholders, and data issues. You can find all the measures at www.cms.gov.  The Star Ratings measures span five broad categories:

  • Outcomes
  • Intermediate Outcomes
  • Patient Experience
  • Access
  • Process

For 2015 Star Ratings, outcomes and intermediate outcomes will continue to be weighted three times as much as the process measure, and patient experience. CMS continues to reduce the overall Star Rating for contracts with serious compliance issues, defined as the imposition of enrollment or marketing sanctions.

Generally, you are limited in the times of year you can enroll in and change Medicare Advantage and Part D plans. A Special Enrollment Period (SEP) allows you to enroll in plans outside of these times.  If you want to enroll in a plan or change plans, you can take advantage of an SEP to join or switch to a five-star Medicare Advantage or Part D plan. You can enroll into a Medicare Advantage Plan or stand-alone Part D plan in your service area that has an overall plan performance rating of five stars. You may only use this SEP once per calendar year. The five-star SEP starts Dec. 8 of the year before the plan is considered a five-star plan, and ends Nov. 30 of the year the plan is considered a five-star plan. Enrollments are effective the first of the following month

For more information on how Star Ratings work click Here.

Medicare's Open Enrollment Begins October 15th

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