Part D drug plans and Medicare Advantage Plans vary greatly in terms of costs and coverage. Each January, plans can change their coverage and costs for the new calendar year. This means that each fall, you should review your plan’s coverage and compare it with other plans in your area to make sure you have the coverage that is best for you. Examine a plan’s coverage, costs, drug coverage, and the pharmacies in its network to see if it best meets your current needs. After considering those factors, you can use the plan’s star rating from Medicare to help you make a final decision.
What is the Medicare Star Rating System?
Medicare uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Medicare scores how well plans perform in several categories, including quality of care and customer service. Ratings range from one to five stars, with five being the highest and one being the lowest. Plans are rated in each individual category. Medicare also assigns plans one overall star rating to summarize the plan’s performance as a whole. You can use the overall star rating to compare performance among several different plans. To learn more about differences among plans, look at plans’ ratings in each category.
Medicare reviews plan performance yearly and releases new star ratings each fall. This means plan ratings may change from year to year.
Medicare Advantage Plans are rated on how well they perform in five different categories:
- Staying healthy: screenings, tests, and vaccines
- Managing chronic (long-term) conditions
- Plan responsiveness and care
- Member complaints, problems getting services, and choosing to leave the plan
- Health plan customer service
Part D plans are rated on how well they perform in four different categories:
- Drug plan customer service
- Member complaints, problems getting services, and choosing to leave the plan
- Member experience with the drug plan
- Drug pricing and patient safety
Remember: Before you consider a plan’s star rating, make sure the plan’s coverage and costs suit your needs. For example, if you are considering a Part D plan, be sure the plan covers you drugs at a cost that works for you.
Where can I find information on my plan’s star rating?
Star ratings can be found using Medicare’s Plan Finder tool or by calling 1-800-MEDICARE. New plan quality ratings come out each October and apply to the next calendar year (for example, plan ratings for 2018 will be available in October 2017).
Note: Star ratings in the Medicare & You handbook may be outdated. For up-to-date information on star ratings, check Plan Finder or call 1-800-MEDICARE.
How can I use the star ratings to inform my plan choice this year?
You can use star ratings to compare plans in your service area by the categories, listed above, that Medicare finds important indicators of plan performance. Remember that a plan’s star rating is only one factor to look at when comparing plans. Even though a plan has a high star rating, it may not be right for you. You should also consider the plan’s costs, coverage, and network for providers and pharmacies.
If Medicare gives a plan fewer than three stars for three years in a row, Plan Finder will flag the plan as low-performing. The symbol Plan Finder uses to show that a plan is low-performing is an upside-down red triangle with an exclamation point inside of it (similar to a caution sign). Medicare will notify you if the plan you are enrolled in is flagged as low-performing. You will not be removed from the plan, but you may want to check the plan’s costs and coverage to make sure it is still a good plan for you.
Note: If you plan to enroll in a low-performing plan, you must call 1-800-MEDICARE or the plan directly. You cannot use Plan Finder to enroll in low-performing plans.
What is the five-star Special Enrollment Period (SEP)?
Generally, you can only change your plan or enroll in a new one during specific times. Special Enrollment Periods are periods of time outside normal enrollment periods, triggered by specific circumstances. If you want to enroll in a plan or change plans, you can take advantage of an SEP to join or switch to a five-star Medicare Advantage or Part D plan. This means that you can enroll in a Medicare Advantage Plan or stand-alone Part D plan in your service area that has an overall plan performance rating of five stars. You may only use this SEP once per calendar year.
- This SEP begins December 8 of the year before the plan is considered a five-star plan (remember that ratings come out in October) and lasts through November 30 of the year the plan is a five-star plan
- Enrollments in December are effective January 1
- Enrollments from January to November are effective the month following the enrollment request
To use the five-star SEP, contact Medicare at 1-800-633-4227.