What is the Medicare plan Star Rating?
The Center for Medicare & Medicaid Services (CMS) uses a five-star quality rating system to measure how well Medicare Advantage and Prescription Drug plans perform in several categories. These categories include 32 quality measures related to Medicare Part C and 15 measures related to Medicare Part D coverage.
These measures are grouped by domains:
- Staying healthy: Evaluate access to preventive services to keep members healthy. This includes physical examinations, vaccinations like flu shots, and preventive screenings.
- Chronic conditions management: Rate care coordination and how frequently members received services for long-term health conditions such as diabetes and hypertension.
- Member experience: Rate the overall satisfaction with the health plan.
- Member complaints: Evaluates frequency of members’ complaints such as issues getting needed services, and disenrollments.
- Customer service: Rate the quality of call center services provided by the plan Customer Service Representatives (including TTY and interpreter services)
- Drug safety and drug pricing accuracy: Plans are rated for whether drug pricing information on Medicare Part D Prescription Drugs website is up-to-date and accurate. This domain also evaluates how many plan members received high risk medications that can cause serious side effects when there may have been a safer drug choice.
What do the Stars Mean?
Medicare plans are rated on a scale of 1 to 5, with a 5-star rating being the highest score a plan can receive. More stars indicate better performance and quality, as indicated below.
***** 5 Stars – Excellent
**** 4 Stars – Above Average
*** 3 Stars – Average
** 2 Stars – Below Average
* 1 Star – Poor
Ratings emphasize member care and satisfaction, using national clinical and service quality measures, health outcomes and member feedback about their health care experience. These ratings are published annually to help consumers compare Medicare Advantage and Prescription Drug Plans on the Medicare Plan Finder. For more information visit Medicare.gov.
Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.