2015 Medicare Advantage Star Ratings

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2015 Medicare Advantage Star Ratings

Each year the Centers for Medicare and Medicaid Services (CMS) rates all Medicare Advantage (Part C) plans and Medicare Prescription Drug Plans (Part D). Ratings are assigned based on a scale from 1 star to 5 stars:

  • 5 Stars - Excellent
  • 4 Stars - Above Average
  • 3 Stars - Average
  • 2 Stars - Below Average
  • 1 Star - Poor

There are currently three dozen measures in five categories which contribute to Medicare Advantage star ratings. Rating factors come from a number of sources such as member surveys, data from physicians, monitoring from CMS, and self-reported information from the plan’s carrier. The following table provides information on factors that determine the overall health plan quality rating for Medicare Advantage plans:

Screenings, Tests & VaccinesWhether plan members received an annual flu shot, screening tests such as glaucoma testing, colonoscopies, and mammograms, and other check-ups to help them remain healthy such as cholesterol tests and checking if members are at a healthy weight
Managing Chronic (Long-Term) ConditionsHow often members with various chronic conditions receive tests and treatments that help them manage their long-term condition. This measure also includes information on hospital readmissions. Examples of chronic health conditions include:

  • Diabetes
  • High Blood Pressure
  • Arthritis
  • Osteoporosis
Plan Responsiveness & CareRatings from members on:

  • Ease of getting information from the plan
  • Ease of getting appointments and receiving care
  • How well the plan coordinated healthcare services for their members
  • Other additional data from member satisfaction surveys
Member Complaints, Issues Getting Services, and Performance Improvement
  • How often CMS found issues with the plan during audits
  • How many members out of 1,000 filed complaints
  • How many members chose to leave the plan
  • The degree the plan’s performance has improved or declined from one year to the next
Plan’s Telephone Customer Service
  • How timely the plan handles new enrollment requests (within 7 days is the benchmark)
  • How well the plan handles phone calls from members
  • Whether hearing-impaired members have access to TTY (teletypewriter) / TDD (telecommunication device for the deaf) services
  • Whether those with a language barrier can receive foreign language interpretation
  • How quickly and how well the plan handles member appeals for health coverage. Appeals are requests members file when they disagree with a plan’s decision about benefits or cost-sharing for covered services or prescriptions (MAPD). An independent reviewer sometimes looks at decisions made by plans and thus plans are also rated based on whether the reviewer approves of the plan’s decision

Star ratings are not currently available for 2015 Medicare Advantage plans but they will be released in late September or early October 2014 and will be available to view through our Medicare plan comparison tool. Check this page again in October for additional information and analysis of 2015 Medicare Advantage plans. Visit our Medicare Part D Star Ratings page for information on 2015 CMS star ratings for Medicare prescription drug plans.