By Sachi Fujimori
When it comes to navigating through many options, expert information can help you make the right decision. Take Medicare, for example. In 2018, the average Medicare beneficiary could choose from among 21 Medicare Advantage plans in their region.1
Medicare Star Ratings help you learn which plans perform best in areas you find important. The federal government (the Centers for Medicare and Medicaid Services, also known as CMS) gives an annual rating to Medicare Advantage and prescription drug plans (Part D), based on categories such as:
Each plan gets one to five stars, with five being the best and one being the worst.
The ratings system helps you understand how well a Medicare Advantage or prescription drug plan is performing.
Star Rating |
What it means |
|---|---|
| (five stars) | Excellent |
| (4 stars) | Above Average |
| (3 stars) | Average |
| (2 stars) | Below Average |
| (1 star) | Poor |
Every plan is evaluated against the same set of criteria. So you have a good way of seeing how the plans available in your area compare to one another.
“A consumer can clearly and appropriately take that as a good objective measure of how one plan stacks up against another,” says Alan Roberts, vice president and head of Star Ratings for Aetna, who works to ensure Aetna delivers benefits, care and service to members in the best way possible. “The beauty of the program is that it takes the complicated health care delivery landscape and sets all of the health plans against the same standards, across a broad set of measures, and so ultimately it’s all very transparent.”
Whether you’re evaluating plans for yourself or a loved one, here are five facts to consider.
Plans receive an overall performance rating. They also receive ratings in a few subcategories. This helps you see if the plan performs well in a specific area that‘s important to you.
The “staying healthy” category includes whether members got their annual flu shot and reported improvements in their physical health over a two-year period.
The “managing chronic conditions” category measures how well plans help members with long-term conditions such as diabetes, rheumatoid arthritis and high blood pressure. It’s calculated from a few data points.These include things like how often patients with diabetes receive recommended screenings and are able to see a specialist. Or if patients with rheumatoid arthritis were prescribed proper medications.
“Maybe you don’t have a lot of clinical conditions to manage, but health care is very confusing to you. Then for you, having a very high degree of service may be top of mind. But, for other individuals wrestling with multiple chronic conditions, understanding how the plan that they’d choose can help support them in their health may be of most interest,” Roberts adds.
Medicare Advantage (Part C) and Medicare prescription drug plans (Part D) are rated in each of the following categories. In addition, plans receive an overall Star Rating to summarize their performance.
Staying healthy: Measures whether members got a flu shot or underwent various cancer screenings, and whether physical health improved after two years.
Managing chronic conditions: Evaluates how often members with conditions such as diabetes or rheumatoid arthritis got the recommended tests and treatments.
Member experience with the health plan: Members rate overall satisfaction with the plan.
Member complaints and changes in plan’s performance: Measures how often members have problems and choose to leave the plan. It also shows if the plan’s performance has improved.
Customer service: Evaluates how well the plan handles customer requests.
Customer service: Evaluates how well the plan handles customer requests.
Member complaints and change in plan’s performance: Measures how often members have problems and choose to leave the plan. It also shows if the plan’s performance has improved.
Member experience with the drug plan: Members rate overall satisfaction with the plan.
Drug safety and accuracy of pricing: Rates whether the plan provides accurate pricing information and if members are being prescribed drugs in a way that is safe and clinically recommended for their condition.
Star Ratings are helpful. But keep in mind that health plans are not one-size-fits-all. “If you just went and looked at the plans available in your service area and decided solely on Star Ratings, you may end up with a plan that doesn’t fit your needs,” says Roberts.
A higher performing plan may not be a good match if:
“These are the things that you should focus on first, before even considering plan quality,” adds Roberts. Read on for the five questions you should be asking to choose the right Medicare plan.
Once you’ve narrowed down your options, Roberts says the Star Ratings can be a “useful barometer” in deciding what plan to choose.
“Clearly if you’re deciding between a 4.5-star plan that has your doctors in-network and has your drugs, versus a similar 3-star plan, the Star Ratings can help make the final decision,” says Roberts.
If you just went and looked at the plans available in your service area and decided solely 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 how to use Star Ratings to help choose a Medicare plan that’s right for you.
For me, the idea of quality health care means being able to give individuals the care they need, when they need it, at the right location.
Aetna’s mission and vision is to help our members lead healthier lives, and so the Star Ratings are a set of quality measures that really fit in very nicely to that mission.
What are Star Ratings?
Star Ratings allow consumers to look across Medicare health plans on a consistent, transparent basis. The government reports on and creates Star Ratings once a year, and those ratings are released right before the Annual Enrollment Period ever year.
Star Ratings are built on a 1 through 5-star scale, such as hotel ratings or restaurant ratings.
How Star Ratings can help consumers choose a Medicare plan
Consumers should really start with understanding what health care means to them. Do they have certain physicians that they see regularly? Do they have certain prescription drugs to manage their conditions? Those should be key inputs into their decision for the right plan for them. Once they’ve identified those unique plans, Star Ratings can help them understand which one will truly give them the best care and outcomes.
Consumers can go on the Medicare.gov website and enter in their ZIP code and the website will pull up all of the different plans available to them. And right there they’ll be able to see the unique Star Ratings of each plan.
Member experience: a key component of Star Ratings
For some individuals, just knowing that the plan service is there to support them when they have questions or may have health care needs is an important indicator of quality.
Jennifer Allen, Aetna Field Case Manager, DNP-PHNL, RN
At Aetna, I’m a field case manager. I’m on the front line with the members. I’m able to visit them in their homes, speak to them on a personal level, and I really get to know them and know what they need.
A home visit is a wonderful opportunity to be able to observe a member in their own environment, uh, you can see the food they eat and the way that they walk around their house and if they need, um, either a device to help them walk or medication.
One of the most positive things with my position here at Aetna is uh, having the one-on-one connection.
What our members are saying:
Janice and Mary are great examples of how Aetna can provide a positive experience to members in many different ways.
Janice Grek - Aetna Medicare Advantage member since June, 2016
We were happy to choose Aetna. We can choose our doctors. One of our doctors retired and it was time to, uh, choose another one just a couple of months ago. And so we were able to find a doctor that we liked very much.
Mary Turner - Aetna member for years, Aetna Medicare Advantage member since January, 2017
The doctors are great. They’ve really been very sensitive, very thoughtful. They take care of me real well. Everybody I’ve ever talked to with Aetna has always helped me.
Can I show you my drinking cup? Aetna is really good. I always take this everywhere I go and I let people see that I’ve got Aetna insurance.”
To learn more, visit www.AetnaMedicare.com/Learn
The Star Ratings system rewards higher-performing plans. This means that those with three or more stars receive annual bonus payments from the CMS. The higher the rating, the higher the bonus.
Plans are required by law to spend this bonus money on extra benefits for members, such as vision, hearing or dental coverage. “Generally speaking, plans with a higher Star Rating, especially plans that are four stars or higher, are likely going to have more benefits than a lower-rated plan. So for the consumer, that means your out-of-pocket medical costs could be less in a highly rated plan.”
Plan ratings are released every fall. So be sure to check and see how your plan is performing. It can help you decide about your coverage for the following year. To learn more, visit the CMS’s Star Ratings page. And check out our section on understanding enrollment periods to determine how and when you can change your coverage.
Sachi Fujimori is a writer and editor based in Brooklyn who focuses on writing about science and health. A good day is one where she eats her vegetables and remembers to live in the moment with her baby girl.
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