Sep 8, 2022
Star Ratings Help Consumers Select Medicare Advantage Plans
Older woman using her smart phone

Star ratings are everywhere. Looking for a car dealer or a car detailer? Many people start their search with Yelp or another site to scope out how others rate the businesses they are considering. The same is true of e-commerce, with rankings visible for all products sold by retailers like Amazon, Etsy, Walmart, and more.

But while purchasing a product that doesn’t quite fit might cause an inconvenience, opting for a Medicare plan lacking in key areas can create larger issues. However, help is at hand – if you know where to find Medicare’s star ratings and how to use them.

About 83 million people in the United States – 18 percent of the population – get their health insurance through Medicare. An increasing number of beneficiaries choose Medicare Advantage (MA) plans and Medicare Part D Prescription Drug Plans (PDPs) offered by private insurers, including Cigna, instead of traditional Medicare.

Each year in October, the Centers for Medicare & Medicaid Services (CMS) rates every Medicare Advantage and PDP in the country. CMS star ratings provide one snapshot into a plan’s quality. Yet, Cigna has found that only about a quarter of Medicare beneficiaries are even somewhat familiar with star ratings and what they represent.

Medicare beneficiaries have different lifestyles, abilities, and needs. Most, but not all, are age 65 or older. Some are healthy, some have disabilities, some are chronically ill. As they age, their needs and situations might change. Medicare Advantage plans offer the flexibility to meet those needs by offering a wide variety of features not covered by traditional Medicare, including vision and hearing coverage, fitness benefits, transportation benefits, virtual care, low out-of-pocket maximums, and special benefits such as meal deliveries after a hospital stay.

New and existing Medicare enrollees can select plans during a variety of enrollment periods, each governed by specific requirements. The majority of beneficiaries that are already in Medicare can select a new Medicare Advantage plan during the Annual Election Period, which runs from October 15 through December 7. In the weeks leading up to that period, recipients can find themselves inundated with direct mail, television commercials, and other communications urging them to switch to a different plan. Weeding through the information can be confusing. Fortunately, star ratings can provide one way to compare to plans.

Read on to learn more about the ratings system and how to find star ratings for the plans you are considering.

  • Star ratings are updated in October of each year, which is when most people are shopping for their Medicare plans. The ratings can be accessed by using the Planfinder tool at Users enter their ZIP code and answer a few questions about what they are looking for in a plan to see a list of plans in their area along with their star ratings.
  • Star ratings are based on a scale of one to five, with five being the highest. The ratings encompass more than 40 factors for quality and performance, including preventive services, access to care, and customer satisfaction. The criteria can change annually based on new areas of focus.
  • Plans that earn four stars and above receive annual quality bonuses from CMS, allowing them to invest further in the benefits they offer. In contrast, plans with continued low ratings can be flagged as “low performing” on Planfinder.
  • Five-star plans are marked with a special five-star icon in Planfinder to make them easy to find. Customers with a five-star plan in their area, such as Cigna's Florida HMO, can use a special enrollment period to change plans one time per year.
  • Medicare Advantage plans that are filed under a new contract are shown as “too new to be rated” for their first two years on Planfinder. Plans filed under an existing contract get the same star rating as the plans already in that contract.

As useful as they are, stars are only one tool to utilize when selecting an MA or PDP plan. For example, independent organizations, such as U.S. News and World Report, rank MA plans on cost and quality. It’s also important to consider other factors, such as cost (including premiums and out-of-pocket maximums), extra benefits (like dental, vision, and hearing) and the provider network included in the plan.

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