Centers for Medicare and Medicaid Services (CMS) Releases Star Ratings for Medicare Advantage Plans
More Medicare Advantage plans nabbed top quality marks for their 2016 plans than last year, a potential sign that private insurers are trying to meet the federal government’s standards for high-quality products and coordinated health care for seniors. But the CMS’ star ratings, released Thursday, also showed that private Medicare plans are still failing on many levels, particularly when it comes to prescription drug benefits. Overall, 81 companies covering 179 individual health plan contracts — or about half of all plans for 2016 — received at least four stars, according to a Modern Healthcare analysis of 2016 Medicare Advantage star-rating data (PDF). That group factors in Advantage plans that also have Part D prescription drug coverage. In 2015, 40 percent of all plans received four stars. When weighted by enrollment, the CMS said almost 3 out of 4 beneficiaries are enrolled in plans that have medical and drug coverage and have garnered at least four stars. The CMS instituted its star rating system for Medicare’s private insurance coverage almost a decade ago as a way to make sure Medicare beneficiaries were getting high-quality care from their insurance companies. Star ratings factor into several measures, including clinical outcomes, patient experience, and access to care. For example, more stars are awarded to health plans with provider networks that routinely check for osteoporosis in women who suffer a fracture and those networks that have lower hospital readmissions. The average star rating among the 369 private Medicare contracts for 2016 was 4.03, according to CMS. Plans can receive anywhere from one to five stars, in half-star increments. The 2016 average was higher than the 3.92 mark for 2015. But not all plans passed with flying colors. Some actually failed outright.
David Wingate is an elder law attorney at the Elder Law Office of David Wingate, LLC. The elder law office services clients with powers of attorneys, living wills, Wills, Trusts, Medicaid and asset protection. The Elder Law office has locations in Frederick and Montgomery Counties, Maryland.