Medicare Star Rating System - American Exchange

Medicare Star Rating System

Transitioning to Medicare once you are eligible can be a daunting task. There are a lot of differences between how Medicare works compared to traditional insurance that you may have had in the past. There are usually a lot more Medicare Advantage (MA) plans, Medicare Prescription Drug (PDP) plans, and/or Medicare Cost plans to consider than individual under 65 options.

Having so many options is a good thing as it increases the chance of you finding the right plan for you.  The Centers for Medicare and Medicaid Services (CMS) realizes the difficulty having so many options can pose to consumers, and created the Star Rating System so consumers can quickly see how well a plan has performed year to year.

Medicare Advantage plans and Medicare Cost plans are rated using five categories:

Staying Healthy – rates whether members were able to get access to sufficient preventative care to help them stay healthy

Management of Chronic Conditions – rates the frequency of services members received for long term health conditions

Member Experience – satisfaction ratings of the plan by its members

Member Complaints – rates how many complaints members submitted, how many members left the plan, had issues getting services, and will show if the plan’s performance from one year to the next

Customer Service – rates quality of call center services, appeal processing, and timeliness new enrollment processing

For plans that include drug coverage, such as Medicare Part D stand alone Prescription Drug Plans and/or Medicare Advantage plans, one other category is rated: Drug safety/pricing accuracy.  This category rates the accuracy of pricing on the websites, and also looks at members who received prescriptions of drugs with serious side effects when a safer drug may have been available.

The Star Rating System is 5 tiered, and the higher the star the better performance or quality of the plan. Ratings are updated and released every fall.

5-star: Excellent

4-star: Above Average

3-star: Average

2-star: Below Average

1-star: Poor

American Exchange recognizes the frustration and confusion trying to choose a Medicare plan can be.  We have experienced agents who are happy to help you understand and compare your options. Contact us at 1-888-995-1674 or email for help going over your plan options.

*Disclaimer: Contacting us by the phone number or email listed above will direct you to a licensed insurance agent.