What Is A Star Rating?
Medicare scores Advantage Plans (Part C) on a five star rating system.
This summary rating gives an overall score on the plan’s quality and performance on 37 different topics in 5 categories:
- Staying healthy: screenings, tests, and vaccines. Includes whether members got various screening tests, a yearly flu shot, and other check-ups that help them stay healthy.
- Managing chronic (long-term) conditions. Includes how often members with different conditions got certain tests and treatments that help them manage their condition.
- Member experience with the health plan. Includes ratings of member satisfaction with the plan.
- Member complaints, problems getting services, and improvement in the health plan’s performance: Includes how often Medicare found problems with the plan and how often members filed complaints against the plan and choose to leave the plan. Includes how much the plan’s performance has improved (if at all) over the last two years.
- Health plan customer service. Includes how well the plan handles calls from members, makes decisions about member appeals for health coverage, and handles new enrollment requests in a timely way.
This information is gathered from several different sources. In some cases it is based on member surveys, information from clinicians, or information from plans. In other cases it is based on results from Medicare’s regular monitoring activities.