What does it mean to be rated a Five (5) Star Plan?
A plan can get a rating from one to five stars. A 5-star rating is considered excellent.
What are the Medicare Star Ratings?
Medicare uses information from member satisfaction surveys, plans, and health care providers to give an over-all performance star rating to Medicare health and prescription drug plans. The overall plan rating gives you a single summary score that makes it easy for you to compare plans based on quality and performance. Our plan’s rating is measured on both the health and drug services that we cover.
The overall score for quality of health services covers 36 different topics in 5 categories:
Includes frequency of screening tests, vaccines, and other check-ups that keep members healthy.
Managing chronic (long-term) conditions
Includes frequency of tests and treatments for members with chronic conditions.
Ratings of health plan responsiveness and care
Includes ratings of member satisfaction with the plan.
Health plan member complaints and appeals
Includes how often members filed a complaint against the plan.
Health plan telephone customer service
Includes how well the plan handles calls from members.
The overall score for quality of drug services covers 17 different topics in the following 4 categories:
Drug plan customer service
Includes how well the drug plan handles calls and makes decisions about member appeals.
Member experience with drug plan
Includes member satisfaction information.
Drug plan member complaints and Medicare audit findings
Includes frequency of member complaints about the drug plan and findings from Medicare’s audit of the plan.
Drug pricing and patient safety
Includes how well the drug plan prices prescriptions and provides updated information on the Medicare website.
What is the 5-star Special Enrollment Period?
The 5-star Special Enrollment Period provides an opportunity for you to switch to a 5-star Medicare Advantage plan without or with prescription drug coverage, or a 5-star Medicare stand-alone Prescription Drug Plan. You may use this 5-star Special Enrollment Period one time between December 8 and November 30 of the next year, provided you meet the plan’s enrollment requirements (e.g., living within the service area, meeting requirements regarding end-stage renal disease, etc). People enrolled in a plan with a 5-star overall rating may also switch to different plan with a 5-star overall rating.
Learn More About Plan Ratings
Visit the Medicare Plan Finder Tool on www.medicare.gov to learn more about plans and see their ratings. You can find a plan’s overall rating on the Plan Results page or view a complete summary of all plan’s quality and performance ratings by clicking “Plan Ratings” on the Plan Results page.