Why Medicare's Star Ratings Are Important When Comparing Plans

Posted July 01, 2022 by Julie Sich

Having trouble deciding which Medicare Advantage plan is right for you? Whether you’re enrolling for the first time or considering a change, look no further than the Medicare Advantage Star Rating system.

Each year, the Centers for Medicare & Medicaid Services (CMS) release star ratings that deliver important information about the quality and performance of specific plans to help Medicare eligible individuals compare them. Medicare Advantage and Part D prescription drug plans are rated on a one to five scale, with five stars representing the best performance and one star the worst.

It’s a critical tool for you to use when considering Medicare coverage options. You can compare quality through the star ratings, even in specific categories, along with cost and coverage, empowering you to make health care decisions that are best for you.

CMS uses more than 40 rigorous quality and performance measures when assigning a star rating to help you determine how well a health plan is performing in five main categories:

• Member experience: Plans are rated on member satisfaction with the health plan.
• Managing chronic conditions: Plans are rated for care coordination and how frequently members received services for long-term illnesses.
• Staying healthy: Plans are rated for how well the health plan maintains the overall well-being of its members, including access to physical exams and preventative services, such as vaccines and various screenings.
• Member complaints: Plans are rated for how frequently members submitted complaints or left the plan altogether. It also rates whether members had issues getting needed services.
• Customer service: Plans are rated for how quickly the health plan responds to members’ needs in regards to receiving care and addressing concerns, including appeals.

For Medicare Part D and Medicare Advantage plans that include drug coverage, Medicare star ratings also include a drug safety score. This rating is based on the plan’s drug pricing accuracy, as well as how often members were prescribed drugs that are safer and clinically recommended for their condition — and avoiding wherever possible those options that come with a high risk of serious side effects.

CMS gathers information from member satisfaction surveys, individual plans and healthcare providers to give an overall performance rating for plans. The star ratings are released in October, just before the Medicare Annual Enrollment Period begins on Oct. 15.

CMS considers any plan with a 4-star rating or more to be an above average plan. If a plan receives fewer than three stars for three years in a row, that plan will be flagged as low performing and CMS will contact you directly so you can consider other options.

How to find Medicare’s star ratings

Anyone can access Medicare’s star ratings for every year since the Medicare Advantage Star Rating system began in 2008 through CMS’s Plan Finder Tool or by calling 1-800-Medicare. You can simultaneously compare plan benefits, costs and star ratings on plans in your area.

The overall star ratings offer a quick summary of a plan’s performance, but you also can look up how the plan scored for individual categories to see how well the plan performed in a specific area that’s important to you.

On the Plan Finder tool, you will see the plan’s overall star rating. Then, when you click “Plan Details,” you can scroll down to Star Ratings and click “Expand All Ratings.” Here, you will see separate star ratings for each subcategory.

SummaCare’s Medicare Advantage Plan’s star rating

At SummaCare, we continually strive for a 5-star rating to deliver our members the highest healthcare value.

We’re proud to share our 2022 Medicare Advantage Plan earned a 4.5 star rating, which underscores our hard work, dedication and commitment to providing high-quality products and services to our Medicare members just like you.

SummaCare’s Medicare Advantage Plan offers everything that original Medicare covers, but adds extra benefits and services. Those extras could include coverage for dental, vision, hearing aids, over-the-counter items, gym memberships and rides to the doctor with much more added each year to meet your needs.

Deciding on a Medicare Advantage plan can feel overwhelming, but knowing the star ratings can help you feel more confident in your decision. 

SummaCare is an HMO and HMO-POS plan with a Medicare contract. Enrollment in SummaCare depends on contract renewal.  Every year, Medicare evaluates plans based on a 5-star rating system.

If you have questions about Medicare, call a SummaCare Medicare Advisor at 330.996.8440 or (toll-free) 888.464.8440 (TTY 800.750.0750). They’re available to take your call from 8 a.m. to 8 p.m., seven days a week. We also offer free informational seminars to learn about SummaCare’s Medicare Advantage Plans.

For more information, compare plans or enroll, visit: http://www.summacare.com/medicare.

H3660_22_332_M Accepted 06112022