What is the {term}? Medicare Star-Rating System

The Medicare Star-Rating System is a method for consumers to evaluate and compare Part D drug plans and Medicare Advantage Plans, which vary greatly in terms of cost and coverage.

BREAKING DOWN Medicare Star-Rating System

Each January, Part D drug plans and Medicare Advantage Plans can change their coverage and costs for the new calendar year. Therefore, users of the plans should review their coverage and compare their plans with other available plans to ensure their coverage is optimal. The Medicare Star Rating System is a method that consumers can use to evaluate the different coverage options.

Measures of the Medicare Star Rating System

The Medicare Star Rating System measures the performance of plan based on several categories including quality of care and customer service. The categories are ranked between one to five stars, with five being the highest and one being the lowest. According to Medicare Interactive, the Medicare Advantage Plans are rated on their performance in the following five different categories:

  1. Staying healthy: screenings, tests, and vaccines
  2. Managing chronic (long-term) conditions
  3. Plan responsiveness and care
  4. Member complaints, problems getting services, and choosing to leave the plan
  5. Health plan customer service

Part D plans are rated on how well they perform in the following four different categories:

  1. Drug plan customer service
  2. Member complaints, problems getting services, and choosing to leave the plan
  3. Member experience with the drug plan
  4. Drug pricing and patient safety

Poor Performing Plans

A plan is found to be low-performing if it receives fewer than three stars by Medicare for three consecutive years. Medicare notifies individuals if their plan has been found to be low-performing. Enrollees can change plans during specific times or during Special Enrollment Periods (SEP), which are times outside normal enrollment periods that are triggered by specific circumstances.

Plan Enrollment

For individuals who want to enroll in or change a five-star Medicare Advantage or Part D plan, they can do so during an SEP. Individuals can enroll in a Medicare Advantage Plan or stand-alone Part D plan that has an overall plan performance rating of five stars. However, an SEP can only be used once a year.  This SEP begins December 8 of the year before the plan is considered a five-star plan and lasts until November 30 of the year the plan is deemed a five-star plan. Enrollments in December are effective January 1, and enrollments from January to November are effective the month following the enrollment request.