When it comes to navigating many options, expert information can help you make the right choice. Let’s look at Medicare, for example. In 2018, the average Medicare beneficiary was able to choose from 21 Medicare Advantage plans in their region. one
Medicare Star Ratings help you know which plants perform best in areas you think are important. The federal government (the Centers for Medicare & Medicaid Services, also known as CMS) gives Medicare Advantage and prescription drug (Part D) plans an annual rating based on categories, such as:
- Client services
- Member Claims.
- Quality of care
Each plan is evaluated against the same set of criteria. So you have a good tool to compare the plans available in your area.
“This system can clearly and accurately represent to the consumer an objective measure of comparison between plans,” says Alan Roberts, Vice President and Head of Star Ratings for Aetna, who works to ensure Aetna offers its members a better level of benefits. , attention and service. “The beauty of the program is that it takes the complicated health care landscape and allows you to compare all health plans to the same standards, across a broad set of parameters, and so ultimately everything is very transparent. ”.
Whether you’re evaluating plans for yourself or a loved one, here are five things to consider:
Subcategory Rating Matter Too
Plans receive an overall performance rating. They also receive ratings in some subcategories. This helps you see if the plan is doing well in a specific area that is important to you.
The “staying healthy” category includes whether members received an annual flu shot and whether improvements in physical health were reported over two years.
The “chronic disease management” category measures how well plans help members with long-term illnesses, such as diabetes, rheumatoid arthritis, and high blood pressure. It is calculated from a few pieces of information, including, for example, how often patients with diabetes have recommended tests and can see a specialist, or whether patients with rheumatoid arthritis were prescribed suitable medications.
“You may not have any medical conditions to manage, but health care is very confusing. So for you, having a highly efficient service may be your top priority. But for other people battling multiple chronic illnesses, understanding how the plan they might choose can help them improve their health might be most interesting,” adds Roberts.
Transcript: Star Rating Categories Infographic.
The stars are not all that matters
Star ratings are helpful. But keep in mind that health plans are not the same for everyone. “If you just looked at the plans available in your service area and decide solely on star ratings, you may end up choosing a plan that doesn’t fit your needs,” says Roberts.
A high-performance plan may not be suitable in these cases:
- It does not offer the right variety of doctors.
- Cannot be used if traveling out of state.
- It doesn’t offer the prescription drugs you need.
“These are the things you need to focus on first, even before you consider the quality of the plan,” adds Roberts.
Star ratings can help you decide
Once you’ve narrowed down your options, Roberts says star ratings can be a “useful barometer” in deciding which plan to choose.
“Clearly, if you’re between a 4.5-star plan that has its doctors in-network and covers your medications, compared to a similar 3-star plan, the star ratings can help you make the final decision,” he says. Roberts.
If you just looked at the plans available in your service area and decide solely based on star ratings, you may end up with a plan that doesn’t fit your needs.
Click to watch Aetna’s Alan Roberts talk about using star ratings to help you choose a Medicare plan that’s right for you.
High performing plans get a bonus
The rating system rewards plans with the best performance. This means that those with three or more stars receive annual bonus payments from the Centers for Medicare & Medicaid Services (CMS). The higher the rating, the higher the bonus.
The law requires plans to spend this bonus money on additional member benefits, such as dental, vision, or hearing coverage. “Generally speaking, plans with more stars in their rating, especially those with four or more stars, are likely to have more benefits than a plan with a lower rating. So for the consumer, that means their out-of-pocket medical costs could be lower in a higher-rated plan.”
Fall is grading season.
Plan ratings are released each fall. So be sure to review and see how your plan is performing. This can help you decide about your coverage for the following year. For more information, visit the Centers for Medicare & Medicaid Services (CMS) star ratings page. And see our explanation of the enrollment periods section to learn how and when you can change your coverage.