I'm choosing a Medicare Advantage plan for next year. What is
the significance of the Medicare Advantage star ratings, and how
can I use them to pick a plan during open-enrollment period?
This year, open enrollment runs from October 15 to December 7,
so now is the time to begin doing your research -- and Medicare
Advantage star ratings are a key factor in choosing a plan. The
ratings assess Medicare Advantage plans on 50 measures in five
categories, focusing primarily on each plan's coverage, the
effectiveness of its communications and its customer service. The
highest rating is five stars.
The first category gauges the plan's effectiveness in keeping
people healthy, including its wellness coverage and the percentage
of patients who receive screenings, tests and vaccines. The other
categories measure how the plan treats chronic conditions; how
quickly patients can get appointments and see specialists; how
responsive the plan is to complaints; and how it handles appeals,
enrollment requests and other customer-service issues. For more
information about the criteria for the quality ratings, see
Choose Higher Quality for Better Health Care
. You can get more information about a plan's ratings and see how
it performs in each category at the plan's page in the
Medicare Plan Finder
(Medicare Advantage plans are called "Medicare Health Plans" in the
Plan Finder).
In general, the plans are getting better. According to a recent
announcement by the Centers for Medicare and Medicaid Services, 127
Medicare Advantage plans received a four-star or five-star rating
for 2013, up from 106 plans in 2012. Still, only 15 Medicare
Advantage plans received a five-star rating in 2013, up from 12 in
2012. These plans are marked with a gold-star icon in the Medicare
Plan Finder. You can switch to a five-star plan anytime during the
year, not just during open-enrollment season, but you have to live
in one of the relatively few areas where a five-star plan is
available: certain counties of California, Colorado, Hawaii, Iowa,
Maryland, Massachusetts, Minnesota, Ohio, Virginia, Washington
State and Wisconsin as well as Washington, D.C.
Along with making it easier to sign up for a five-star plan, the
Centers for Medicare and Medicaid Services is trying to discourage
people from signing up for low-performing plans. If you are
currently in a plan that has received fewer than three stars for at
least the past three years, you will receive a letter during the
last week in October pointing out the plan's low rating and
reminding you that you have the opportunity to switch to another
plan during open enrollment. Only ten Medicare Advantage plans
received the low-performing rating for the past three years. For
more information, see the
Medicare Plan Finder
.
A plan's quality rating isn't the only consideration. Also focus
on the plan's cost and coverage. Check out the plan's premiums plus
co-payments for your drugs and the medical expenses you typically
have, as well as the plan's out-of-pocket maximums (the most you'd
have to pay for premiums, deductibles and co-payments over the
year). And make sure the plan covers the doctors, hospitals,
pharmacies and other providers you typically use. Many plans have
been shrinking the size of their networks, so you can't assume the
providers you used in the past are still on the in-network
list.
For more information about all of the factors to consider when
choosing a Medicare Advantage or Medicare Part D plan for 2013, see
Sift Through Your Medicare Choices
and
What to Know About 2012 Medicare Open
Enrollment
.