Medicare Star Ratings - Your Guide To The Perfect Plan

By: Edward Neeman
Published: Thursday, October 04 2018
Last Updated: a month ago

Finding the right Medicare plan is no easy task, but it’s important you do. Thankfully, the CMS makes things a little easier on you with their Medicare Star Ratings. So, if you’re in the market for some coverage and want to find the best plan for you, here’s how the Star Rating system can help you.

What Are Medicare Star Rating?

The Centers for Medicare and Medicaid Services (CMS) have a star rating system that can help people choose which Medicare plan is best for them. Medicare star ratings range from 1 to 5, indicating how poor or excellent the plan's quality is.

How Ratings Are Calculated

Medicare star ratings are given based on five categories. The star rating system considers if its members are staying healthy if they have cared for chronic health conditions, their satisfaction, and experience with the plan, any complaints they have about the plan and the customer service. For Medicare Part D plans that include drug coverage, Medicare star ratings also include the safety and prices of drugs.

When Are CMS Ratings Released?

CMS star ratings are the same as Medicare star ratings. The star rating system is five stars based on the same five categories. CMS star ratings are released once in July and a second time in December. They are required to collect data from the HEDIS, or Healthcare Effectiveness Data and Information Set.

How To Compare Plans Using The Star Rating System

People can use the star ratings to determine which plan they should be signing up for. Besides high ratings, people should also consider the costs and coverage of the plans. For example, if the plan covers whatever needs they have and is worth the amount of money they pay. A plan can still be a good fit even if it's flagged as below average.

The Healthcare Effectiveness Data and Information Set is used to improve CMS star ratings. HEDIS is also used when determining which plan is the best one to sign up for. The results are starting to be used to keep track of performance every year.

Is A 5-Star Plan Right For You?

When looking for a plan to sign up for, most people probably start off with the 5-star plans. Since those plans have the highest rating, they must provide the best quality coverage. They will if their services meet your needs. People who are signing up for the first time will have to choose between Original Medicare and Medicare Advantage.

Original Medicare is made up of Part A which provides hospital coverage, and Part B which provides various medical coverage. For most people, Part A is free and they pay $134 a month for part B. People who deduct the premium from their Social Security pay one hundred nine dollars a month.

Medicare Advantage is actually it’s own Medicare plan that is known Part C. Parts A and B are covered by a private insurance company. There are deductibles and copays depending on the plan you choose. So, the first big decision is whether to sign up to the original plan or the advantage plan.

Why A 5-Star Plan Might Not Be Best

5-star plans may seem like the best ones to choose because of their excellent ratings. But that rating might not mean it's within your budget or meets your medical needs. A 4-star or 3-star plan might be more affordable and include the services you're looking for. Everyone has different needs, and will, therefore, have different experiences with each plan.

A high rating plan won't be so appealing if it doesn't provide the quality care that you need. That could be hundreds of dollars that you wasted thinking you were getting the best of the best.