Medicare: What are the STAR ratings?

Many of our clients ask us what the STAR ratings for each health plan really mean.

Medicare.gov gives us the answer as:

For plans covering health services, the overall score for quality of those services covers 36 different topics in 5 categories:

• Staying healthy: screenings, tests, and vaccines: Includes whether members got various screening tests, a yearly flu shot, and other check-ups that help them stay healthy.
• Managing chronic (long-term) conditions: Includes how often members with different conditions got certain tests and treatments that help them manage their condition.
• Member experience with the health plan: Includes ratings of member satisfaction with the plan.
• Member complaints, problems getting services, and improvement in the health plan’s performance: Includes how often Medicare found problems with the plan and how often members filed complaints against the plan and choose to leave the plan.  Includes how much the plan’s performance has improved (if at all) over the last two years.
• Health plan customer service: Includes how well the plan handles calls from members, makes decisions about member appeals for health coverage, and handles new enrollment requests in a timely way.

For plans covering drug services, the overall score for quality of those services covers 15 different topics in 4 categories:

• Drug plan customer service: Includes how well the plan handles calls from members, makes decisions about member appeals for drug coverage, and handles new enrollment requests in a timely way.
• Member complaints, problems getting services, and improvement in the drug plan’s performance: Includes how often Medicare found problems with the plan and how often members filed complaints against the plan and choose to leave the plan.  Includes how much the plan’s performance has improved (if at all) over the last two years.
• Member experience with plan’s drug services: Includes ratings of member satisfaction with the plan.
• Patient safety and accuracy of drug pricing: Includes how well the plan provides accurate pricing information for the Medicare website. Includes information on how often members with certain medical conditions get prescription drugs that are considered safer and clinically recommended for their condition. Includes information on whether members are taking certain medications as directed.

For plans covering both health and drug services, the overall score for quality of those services covers all of the 48 topics listed above.

We hope that helps answer most seniors questions about the STAR ratings. More in depth information can be found right on the Medicare.gov website by clicking here.

As always if you have any questions about Medicare STAR ratings, or any other Medicare related benefit issues, please do not hesitate to contact your Total Benefit Solutions account manager at (215)355-2121.