How Do Star Ratings Work?

Whether you’re new to Medicare or just exploring your options for the next annual open enrollment period, choosing the best Medicare coverage for your needs can take a fair amount of research. Often, you’ll want to compare costs and coverage options among the various plans available in your area. Medicare star ratings can help you with this process. 

What Are Medicare Star Ratings?
Medicare uses a star rating system to rank quality among Medicare plans administered by private insurers. That includes Medicare Advantage plans (Medicare Part C) and Medicare Part D Prescription Drug plans. Medicare reviews star-rated plans based on quality and performance each year. New ratings are announced every October. 

The stars aren’t relevant for Original Medicare Part A and Part B because Original Medicare is administered through the government. But you can still use the star system to help pick your Part D plan if you choose to buy prescription drug coverage along with Original Medicare.

How Do Medicare Star Ratings Work?
Medicare uses stars to rate Medicare Advantage and Part D plans. They’re each given an overall rating as well as ratings in individual categories (see below). 

Ratings range from one to five stars. Five stars are considered excellent, four is above average, three stars is average, two stars is below average, and a one-star rating means poor. Let’s take a look at the specifics of what’s evaluated in each kind of plan. 

Medicare Advantage
Medicare Advantage plans are provided by Medicare-approved private insurers and must offer all of the benefits in Original Medicare Part A and Part B. Many offer additional benefits such as some vision and dental coverage. In many cases, Medicare Advantage plans also incorporate Part D prescription drug coverage into the plan. 

In the star rating system Medicare Advantage plans are ranked based on how well they perform in five categories: 

  1. Member health
  2. Managing chronic conditions
  3. Member experience
  4. Member complaints
  5. Customer service

Part D plans 
Part D prescription drug coverage plans were established in 2006 to help seniors pay for the cost of medicines. They are offered by Medicare-approved private insurers and usually charge premiums and some type of copayments. These plans are rated on how well they perform in four categories: 

  1. Customer service
  2. Member complaints
  3. Member experience
  4. Drug pricing and patient safety.   

How to Best Use Medicare Star Ratings
Medicare plans can vary widely in cost and coverage. Star ratings are just one of a variety of factors to consider when you’re looking for a plan. Others might include price, whether your doctors are in the network, or whether the services you want are covered, among other factors.  

For instance, a five-star Part D plan in your area may not cover the drugs you need while another plan with a lower star rating does. Or a Medicare Advantage plan in your area may have a five-star ranking but it may not include your doctors in its network.  

What’s more, plans may change their coverage and costs each year, which can affect their star ratings as well as how desirable they are to you. 

You can find the latest star ratings when you use the Medicare Plan Finder tool or by calling 1-800-MEDICARE. Keep in mind that the star ratings you see in the annual “Medicare & You” handbook you receive in the mail each fall are outdated.  

To learn more about choosing the Medicare coverage that’s right for you, speak to one of our agents. 

Return to: Medicare 2021

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