What is the Five-Star Quality Rating System?

Medicare’s Five-Star Quality Rating System is the way in which Medicare evaluates the service and quality of health and drugs of Medicare Advantage plans. This evaluation considers more than 50 grouped aspects in different categories. The plan’s Star Rating changes every year and the results are available every autumn.

In addition to assigning the plan a quality rating, with these evaluations, Medicare assures that health plans take responsibility for the care and health of its affiliates, and that these are satisfied with the services they receive from the plan. The purpose is to ensure a great service experience and to improve the plan affiliate’s health.

How is the Star Rating determined?

Medicare health plans are evaluated and rated in 5 categories:

  1. What the plan does to maintain its affiliates healthy (Evaluations, medical exams and vaccines)
  2. Control of chronic sicknesses (Diabetes, arterial pressure, rheumatoid arthritis, and others)
  3. The plan member’s experience
  4. Patient’s complaints, services inconveniences and improvement in the plan’s performance

Medicare prescripted drug plans are evaluated and rated in 5 categories:

  1. Customer service
  2. Patient’s complaints, services inconveniences and improvement in the plan’s performance
  3. Experience between the members and the prescripted drugs plan
  4. The drug’s price and the patient’s security

What do the stars mean?

The plan may obtain from one to five stars. (Some plans maybe too new or not have enough data to be rated.)

Excellent
Over the average
Average
Sub average
Bad

Why is my plan’s rating important?

The Centers of Medicare and Medicaid Services (CMS) recommend the use of the Star Quality Rating along with the information about costs and coverage benefits to compare plans and choose the one that best suits your needs.

  • Check if the plan had a better rating this year than last year
  • If the plan that interests you has received a low rating constantly, look check in the details (services) in which it has received a low rating to make sure that it is the right plan for you.