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Comparing Medicare Advantage Plans and Medicare Part D drug plans means taking a look at prescription drug coverage, copays and coinsurance costs, the plan’s network of doctors and service area. But there’s another metric you should consider when making your decision: the plan’s star rating.
What is the Medicare star rating system?
As with most rating systems, the Medicare star rating helps rank plans from best (5 stars) to worst (1 star). The ratings are generated by the Centers for Medicare and Medicaid Services, or CMS, and they’re based on the plan’s quality of care and measurements of customer satisfaction. You can find a plan’s rating with the Medicare Plan Finder.
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This metric has the potential to change each year, as CMS reviews and updates ratings based on plan changes. Ratings are released in October, unless plans are new to the marketplace (in which case, they won’t have ratings yet).
Medicare Advantage Plans
Medicare Advantage ratings are based on the following five categories:
- Member experience: How do members rate things like ease of seeing specialists and getting appointments quickly?
- Plan performance: What is the complaint history of the plan, and has its performance gotten better or worse over time? Are members leaving the plan?
- Customer service: How well does the plan respond to member requests and appeals?
- Staying healthy: Do members have access to checkups, vaccinations and screening tests that help them stay in good health?
- Chronic conditions: Do members with chronic conditions get the kinds of tests and treatments that would typically be recommended to them?
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Medicare Part D prescription drug plans
Medicare Part D plan ratings are based on the following four categories:
- Member experience: How do members rate the plan?
- Plan performance: What is the complaint history of the plan, and has its performance gotten better or worse over time? Are members leaving the plan?
- Customer service: How well does the plan respond to member requests and appeals?
- Drug safety and pricing: How accurate is the plan’s pricing information? Are members with specific medical conditions prescribed drugs appropriately and safely?
Enrolling in a 5-star plan
You can enroll in a 5-star Medicare Advantage or Part D plan during the following enrollment periods:
- Initial Enrollment period (when you’re new to Medicare — three months before you turn 65, the month you turn 65, and the three months after that month).
- Open Enrollment period (Oct. 15 to Dec. 7 each year).
- Medicare Advantage Open Enrollment period (Jan. 1 to March 31 each year, if you already have an MA plan).
- Special Enrollment period, as described below.
No matter what your current plan is rated, if you want to enroll in a 5-star Medicare Advantage or Part D plan, you can switch to one during a Special Enrollment period — which exists for just this purpose — from Dec. 8 to Nov. 30 of the following year. You may do this only once during this time, and it’s possible only if a 5-star plan is available in your area. (Not all areas have 5-star plans available.)
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If you’re enrolled in a plan that’s been rated less than 3 stars for three years in a row, you’re allowed a one-time chance at any time to enroll in a better plan.
For questions about Medicare plans and other Medicare issues, contact Medicare at 1-800-MEDICARE (1-800-633-4227) or visit Medicare.gov.
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Kate Ashford writes for NerdWallet. Email: USexpansion@nerdwallet.com.
