Millions of Medicare recipients each year choose to enroll in a Medicare Advantage (MA) plan. Offered by private insurance companies approved by Medicare, Medicare Advantage plans are required to provide the same coverage as Original Medicare Parts A and B, but many offer additional benefits. Some MA plans provide invaluable services that Original Medicare does not. These additional benefits can include:
- Vision and dental care
- Hearing exams
- Fitness club memberships
- Prescription drug coverage
- Post-hospitalization home meal delivery
Medicare Advantage plans also have an out-of-pocket maximum to prevent medical expenses from breaking the bank. These additional benefits may appeal to you, but you may wonder, “Are are all MA plans alike?”
The Centers for Medicare & Medicaid Services (CMS) introduced a ratings system to help you determine which plans meet and exceed expectations in a number of areas. The Star Ratings program uses information from member satisfaction surveys, plans, and health care providers to give overall performance ratings to plans. A plan’s rating can range between 1 and 5 stars. A 5-star rating exemplifies the highest level of quality and performance.
What are the ratings based on?
Star Ratings are based on a number of factors, including:
- Member statistics, including the percentage of members who undergo appropriate screening tests, vaccines, and other preventive services
- Management of long-term chronic conditions
- Number of complaints from Medicare or plan members
- Customer service handling of appeals, including timeliness and fairness of appeal consideration
- Availability of TTY and foreign language interpretation
- Percentage of members who leave the plan
- Compliance with Medicare rules and regulations
Medicare Advantage plans with prescription drug coverage (MA-PDs) and stand-alone Prescriptions Drug Plans (PDPs) are also rated on the plan’s drug services. These drug benefits are rated on:
- Drug safety
- Accuracy of drug pricing
- Customer Service handling of appeals
- Member complaints
- Changes in plan over time
Five Star Medicare Plan Special Enrollment Period
Medicare recipients are granted a Five-Star Special Enrollment Period from December 8 through November 30. During this SEP, you may switch plans once to a 5-Star Medicare Advantage, 5-Star Medicare Cost Plan, or 5-Star Medicare Prescription Drug Plan available in your area.
Many people enroll in a Five-Star Medicare Advantage Plan when they are first eligible for Medicare due to age or disability. Some choose to join a plan during the Annual Election Period (AEP) each year. AEP allows Medicare recipients to make changes to their coverage. AEP begins October 15 and ends December 7. During this time, you can drop Original Medicare and enroll in a Medicare Advantage plan, with or without prescription drug coverage. You can switch from one MA plan to another. You can switch from one stand-alone Prescription Drug Plan (PDP) to another PDP. You can also drop your MA plan and revert to Original Medicare.
The Star Ratings are updated each fall to provide the most current reviews of plans available in your area. Medicare Advantage plans can vary in cost and coverage. Compare plans before enrolling and find the one that meets your specific needs and preferences.