Medicare star system
If you become eligible for Medicare this year or are considering switching plans when open enrollment season starts, our guide will help you decide which plan is best for you. Before you do, it’s important to know that Medicare uses a 5-star rating system to measure the quality of health insurance plans.
Plans with higher Medicare star ratings have proven higher quality (which may mean more doctors in-network, better care, or more care options), while lower ratings have not. Knowing what these Medicare star ratings mean and how to utilize them in your search for the best health insurance can be a massive help in deciding which plan is best for you.
What are the Medicare star ratings?
Medicare uses a system that assigns each plan a star rating from one to five stars. Plans with higher ratings offer higher quality, meaning they offer better care at lower costs through well-known providers and hospitals in their network.
They also offer more favorable customer service hours and higher satisfaction ratings from beneficiaries who have used them in the past year. Although 5-star plans are ideal, this rating is extremely difficult to achieve.
The star rating breakdown:
Five stars
The highest possible rating given by Medicare and means that beneficiaries will have access to a wide range of doctors, hospitals, and other providers in their network without cost-sharing or restrictions. This includes specialists such as cardiologists and cancer surgeons—even if they’re outside your plan’s local area.
You’ll also be able to see all pricing information before you sign up for coverage, so you’ll know how much each doctor visit costs ahead of time. And when it comes time to go into the hospital or need nursing home care, there won’t likely be any surprises about what bills might come due since everything should already be spelled out in your plan.
Four stars
The next highest rating and means that beneficiaries will continue to have access to a broad range of doctors, hospitals, and providers in their network. This plan is considered above average and the highest number of Medicare plans fall into this rating.
Three stars
Three stars indicate that beneficiaries can choose from more than one provider within their plan’s healthcare providers network. This includes specialists such as cardiologists and cancer surgeons—even if they’re outside your plan’s local area. You’ll also be able to see pricing information before you sign up for coverage, so you’ll know how much each doctor visit costs ahead of time.
Two stars
Two stars indicate that beneficiaries can choose from one provider within their plan’s network without cost-sharing or restrictions.
One star
One star means the beneficiary will have access to only a single, non-network physician in their region who is contracted with Medicare.
What Medicare Advantage Plans have a 5-star rating?
Like we said, 5-star ratings are very hard to achieve for insurance companies and the Medicare advantage plan they offer. This is done intentionally to keep competition among plans. Sometimes it’s something as medial as not offering transportation coverage that can drag down their 5-star to a 4.5. Plus, a lot of their fate lies in the hands of their members, who leave reviews each year indicating how well they met all levels of care.
Medicare Advantage plans have more stringent criteria to meet their star rating than other Medicare Plans, such as prescription drug coverage. In general, you can change your plan or enroll in a new one only during a Special Enrollment Period. Their star rating is based on how well they do in each of the following categories:
- Staying healthy (member access to screenings, tests, vaccines, etc.)
- Chronic condition management
- Overall satisfaction with care and health plan responsiveness
- Member complaints and members leaving the health plan
- Customer service rating
Despite these regulations and categories, there are plenty of Medicare Advantage plans with near five-star ratings to their beneficiaries. Therefore, including Medicare Advantage plans in your search for the best health insurance can be a wise decision.
Get Help From The Pros
As you search for the right Medicare plan, and Medicaid services, you can compare plans based on your specific needs, plus filter by drug coverage, special coverages, and star rating at Medicare.gov. Our Ōmcare customer care team is available 24/7 to answer any questions and provide the expert support you and your loved ones need.