Decoding Star Ratings:
How to Use CMS Quality Ratings to Pick a Top Medicare Plan
When comparing Medicare Advantage and Part D plans, premiums and benefits are important. However, the Medicare Star Rating is another valuable tool that can help you evaluate plan quality.
What Are Medicare Star Ratings?
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage and Part D plans on a one-to-five-star scale, with five stars representing the highest rating.
CMS evaluates plans on factors such as:
- Quality of care
- Member experience
- Health outcomes
- Customer service
- Prescription drug services
- Medication adherence
A higher rating generally indicates stronger performance in these areas.
Should You Choose the Plan With the Most Stars?
Not necessarily. A five-star plan may perform very well but may not be the best fit for your individual needs.
When comparing plans, also consider:
- Are your doctors and hospitals in the network?
- Are your prescriptions covered?
- What will your medications cost?
- What are the copayments and deductibles?
- What is the maximum out-of-pocket cost?
- Are your preferred pharmacies included?
- Does the plan require referrals or prior authorization?
The Star Rating should be viewed as one part of the overall decision.
Do Not Overlook Part D Ratings
If prescription drug coverage is important to you, review the plan's Part D performance as well. A highly rated drug plan may still have higher costs for your specific medications.
Your prescriptions, drug tiers, deductible, pharmacy network, and estimated annual costs should all be reviewed before making a decision.
Star Ratings Can Change
CMS updates Medicare Star Ratings each year. A plan's rating can change based on its performance, so it is important to review your coverage annually rather than assuming your current plan remains the best option.
How Otium Financial Planners Can Help
At Otium Financial Planners, we help Medicare beneficiaries compare plans based on more than just premiums.
We can help you review Star Ratings, provider networks, prescription coverage, costs, and benefits to determine which options best fit your individual needs.
Star Ratings are a valuable tool for comparing Medicare plan quality, but they should not be the only factor in your decision.
The best Medicare plan is not necessarily the plan with the most stars. It is the plan that best fits your healthcare needs, providers, prescriptions, and budget.
This article is for educational purposes only and is not intended as personalized Medicare, insurance, or financial advice. Medicare plan benefits, costs, networks, and Star Ratings may change annually.
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