We are now in the middle of Medicare’s Open Enrolment Period, and seniors are inundated with ads for competing plans. How can a senior evaluate those competing plans and what they offer? This is a key decision that may affect a senior’s life in fundamental ways, so choose carefully.
First, remember some basic facts. There are two main ways to get Medicare coverage: Original Medicare and Advantage Plans, also called “Part C.” An Advantage-type plan is a Medicare-approved plan sold by a private company that offers an alternative to Original Medicare. Advantage plans bundle Original Medicare Part A (hospital insurance), Part B (doctor visits, labs, etc.) and usually Part D (drug coverage).
Advantage plans may have lower out-of-pocket costs than Original Medicare, but they require you to use doctors and other medical providers who are in the plan’s network. Advantage plans may also offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services. All Original Medicare supplemental plans are the same if they have the same plan letter designation. However, Advantage plans can vary widely from one seller to another, and there can be big differences in the quality of care and patient satisfaction. How can a senior determine which of the many Advantage plan offerings has the best track record?
Fortunately, the Medicare system itself offers some help. The Centers for Medicare & Medicaid Services (CMS) publishes the Medicare Part C and D Star Ratings each year to measure the quality of health and drug services received by beneficiaries. This rating system provides Medicare beneficiaries with meaningful information about the quality of care and the cost of plans available to them.
Medicare uses a Star Rating System to measure how well Advantage and Part D plans perform. A plan may receive from one to five stars, five being the highest rating. These scores are based on how well plans perform in several categories, including quality of care and customer service. These scores are released each year and reflect performance over the preceding 12 months. Remember that a plan’s performance may change from year to year. Advantage Plans are rated on how well they perform in five different categories:
• Plan responsiveness and care
• Health plan customer service
• Member complaints, problems getting services, and choosing to leave the plan
• Managing chronic (long-term) conditions
• Staying healthy: screenings, tests, and vaccines
Part D plans are also rated on how well they perform in different areas, including customer service, member complaints, choosing to leave the plan, drug pricing, and patient safety. Use the star rating to compare performance among different Advantage plans. When you consider a plan’s star rating, make sure the plan’s coverage and costs suit your needs. If you are considering a Part D plan, be sure the plan covers the drugs you are taking at a suitable cost. For an Advantage plan, look carefully at the physicians, hospitals, and other providers in the plan’s network.
You may have heard that 5-star ratings have been harder to come by this year. It is true, the number of 5-star rated plans for 2023 is lower than it was in 2022. This is due in part to changes in rules that were applied to the special circumstances of the pandemic. Those rules have now been tightened and the standards may be higher, thus fewer Advantage plans meet them. The CMS reports that 51% of Advantage plans with drug coverage will have a four-star rating or higher in 2023, a drop from 68% in 2022.
There is a simple way to find highly-rated Advantage plans available in your area. Go to the Medicare Administration’s website at www.medicare.gov and enter your zip code. Use the dropdown box to filter the results by star ratings and you will see a list of plans that meet your criteria. If filtering for only five-star plans yields no available results, try filtering for “four and up.”
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