- CMS has updated the 2018 Medicare Advantage star ratings on health plans, allowing consumers to explore options that will best suit their individual needs.
The star ratings are based on several consumer engagement and care quality criteria, including the effectiveness of a plan’s chronic disease management services, the quality of customer service, and how well a health plan handles customer appeals.
“Medicare is committed to empowering seniors to choose high-quality health and drug plans that fit their needs and the needs of their families,” said CMS Administrator Seema Verma in a press release. “More high-quality choices mean improved quality care and better customer service at lower cost. Medicare Open Enrollment begins soon and the star ratings helps people with Medicare shop to find the best choice possible.”
Also included in MA star ratings are measurements of prescription drug performance including drug safety, drug pricing, and how well beneficiaries responded to drug treatments.
Medicare conducts member surveys and gathers information from clinicians, health plans, and regular Medicare monitoring activity.
The new ratings are good news for some health plans, but others have seen their ratings reduced due to their prior year’s performance.
Anthem announced in a press release that 60 percent of their MA plans would have four stars or better which is an increase from only 22 percent of 2016 MA plans with four or more stars.
“In addition, 2018 also marks the first time at least one of Anthem’s affiliated health plans will be rated five stars by CMS’ Medicare Star Ratings program. The Company’s affiliates will be offering five-star PPO plans in the New Hampshire, Georgia, and Kentucky markets,” the payer added.
Conversely, Health Net of California’s MA plan will drop to a 3.5 star rating from a 4 star rating in the previous year because of information gathered by a 2015 Medicare audit that found beneficiary access and performance problems.
"Our commitment to quality remains as strong as ever. We are working to evaluate and mitigate the potential impact on the Company's revenue in 2019 as a result of the lowered 2018 rating and working to implement year-over-year quality improvements. We believe we will return to a 4.0 Star parent rating in future periods," said Marcela Manjarrez-Hawn, Senior Vice President, Chief Communications Officer.
"To fulfill our commitment, we continue investing in staffing, technology, plan benefits and the consumer experience."
Editors Note: This article was updated to include CMS Administrator Seema Verma's comments.