For over 15 years, the Centers for Medicare & Medicaid Services (CMS) has used a five-star quality rating system to measure the experiences Medicare members have with their health plan. These ratings are indicators of member experience, quality care received from health care providers and much more. It is crucial for those aging into Medicare, as well as current and prospective Medicare beneficiaries, to understand what these star ratings mean and where to find them.
What are Star Ratings?
A Medicare Advantage plan’s star rating is one of the most accurate indicators of a Medicare Advantage plan’s value because it considers care received from health care providers, health plan operations and member satisfaction scores. The scores for these measures are averaged and reported on an annual basis so the star ratings accurately reflect the quality of care and service members receive. Star ratings encourage Medicare Advantage plans to partner closely with health care providers to continuously improve the care and coverage options they offer their members.
How Does the Scale Work?
CMS rates plans on a scale of 1 to 5, with 5 being the highest. These ratings are a reliable tool for comparing health plans, but members aren’t the only ones who benefit from higher ratings. CMS awards quality bonus payments to plans that receive an overall rating above a 4 Star. These quality bonus payments are reinvested back into plans to lower member cost sand expand member benefit programs.
- Clinical Health Care Measures – Ratings are comprised of several measures that evaluate members getting appropriate preventive care, taking medications and managing health conditions. The provider network, respective care options and patient experience are taken into consideration. Generally speaking, higher scores are the result of more care and coverage options and a higher number of satisfied patients within a network.
- Plan Administration and Benefits – Plans and plan administrators are also extensively evaluated by CMS. Everything from customer service to the member benefits a plan offers are reflected in the plan’s star rating. Plans that receive high star ratings are typically focused on improving coverage options, optimizing network provider relationships and revitalizing plans with additional member benefits.
- Member Experience and Satisfaction – One of the best ways to gauge a plan’s success is to ask those it directly impacts—the members. CMS gathers customer feedback and responses from surveys that ask members about their satisfaction with their health plan, providers and perceptions about whether their health is improving. The results of the surveys are included in the overall star rating calculation.
Where to Find Your Plan’s Star Rating
Star ratings are posted on a health plan’s public website. They are also found within the initial information or plan materials members receive after enrolling. Additionally, a plan’s customer service and quality teams can provide star rating information.
Star ratings and national plan comparisons are available on Medicare.gov for those who are researching their plan options or considering a plan change during the next enrollment season.
Why Star Ratings Matter to You
As you navigate your Medicare plan options, it is important to find a plan that allows you to optimize your personal health care needs. Priorities should include finding a plan that includes your primary and specialty care doctors, prescription drug coverage and supplemental benefits and programs that fit your health needs. In addition, choosing a plan with a high star rating not only ensures your health care will be high quality but that your experience as a plan member will also be positive.
So, How Does Network Health Measure Up?
At Network Health, we know that by meeting the needs of our members, we are working toward our mission to create healthy and strong Wisconsin communities. Network Health currently exceeds the national average star ratings, holding an overall rating of 4.5 for our PPO Medicare Advantage plans. Network Health is one of four health plans in Wisconsin to receive this score. Network Health is within the top 25 Medicare plans in the nation.
Our goal is to care for our members by providing access to high-quality care and offering exceptional benefits to optimize their everyday wellness. Visit networkhealth.com to learn more about our member wellness benefits, and explore our Medicare Advantage plan offerings.
Every year, Medicare evaluates plans based on a 5-star rating system. Network Health Medicare Advantage Plans include MSA, HMO and PPO plans with a Medicare contract. NetworkCares is a PPO SNP plan with a Medicare contract and a contract with the Wisconsin Medicaid program. Enrollment in Network Health Medicare Advantage Plans depends on contract renewal. Y0108_2872-01-0120_M Approved 02012020