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The importance of Medicare plan Star ratings

Every year, the Centers for Medicare & Medicaid Services (CMS) uses a five-star quality rating system to measure the experiences Medicare members have with their health plan. 

Plans are rated using a scale of 1 to 5, with 5 being the highest. Ratings are a reliable tool for comparing health plans, and members benefit from choosing a plan with a higher rating. 

Additionally, CMS awards quality bonus payments to plans with an overall rating above 4 stars. These quality bonus payments are reinvested back into plans to reduce the cost to the member and expand benefit offerings, the higher the rating—the more funds are reinvested.

One of the areas of focus for the ratings is member experience and satisfaction. Using these measures, CMS gathers customer feedback and responses to surveys asking members about their satisfaction with their health plan, providers and perceptions about whether their health is improving. 

The results of these surveys are included in the overall star rating calculation.

Star ratings are posted on a health plan’s public website. 

They are also found within initial information or plan materials members receive after enrolling. Star ratings and national plan comparisons are available on for those who are researching their Medicare Advantage plan options or are considering a plan change during the next annual enrollment period. 

When choosing a Medicare Advantage plan, it’s important to find a plan that meets your needs. 

You should look for a plan that includes your primary and specialty care doctors, prescription drug coverage and additional benefits, like fitness, dental and vision. 

When you choose a plan with a high star rating, it can mean a more positive personal experience with the health plan and you may find yourself staying with the plan longer.

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Kimberly Swanson
Vice President Quality and Clinical Integration with Network Health

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