Sometimes, it can be hard to know if you’re getting the right healthcare plan for you. Fortunately, Medicare simplifies the process by offering a few general plans that fit most people’s needs, plus more specialized options like the Special Needs Plan (SNP). However, even with relatively straightforward plan options, costs and coverage can still change from year to year. As a result, Medicare has implemented the Medicare Plan Star Rating System to help people find the best plan for them.

So, what is the Medicare Plan Star Rating System? How are the ratings measured? Finally, what do you need to know about the Medicare Plan Star Rating System to find the right plan for your needs? Read on to find out.

What is the Medicare Plan Star Rating System?

The Medicare Plan Star Rating System evaluates the efficacy of Medicare Advantage and Part D plans. The ratings can change every year, giving consumers greater insight into every plan’s performance. For Medicare Advantage, the Medicare Plan Star Rating System looks at the following categories:

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  • Screenings, tests, and vaccines
  • Management of long-term conditions
  • Plan responsiveness and care
  • Complaints, issues accessing services, and choosing to leave the plan
  • Customer service

Alternatively, the Medicare Plan Star Rating System evaluates Part D plans a little differently:

  • Customer service
  • Complaints, issues accessing services, and choosing to leave the plan
  • Member experience
  • Drug pricing and patient safety

Based on the criteria listed above, Medicare designates a star rating between one and five stars, with a five-star rating reflecting the best possible plans. The Centers for Medicare & Medicaid Services (CMS) conducts thorough investigations of every plan to reach a verdict on its score, updating the scores for every plan on an annual basis.

What Else Do You Need to Know About the Medicare Plan Star Ratings?

The Medicare Star Rating System is one of the best and fastest ways to evaluate the quality of a Medicare Advantage or Part D plan. However, the star rating is definitely not the only factor you should consider. For example, the evaluations of Medicare Advantage plans do not take costs into account, while the evaluations of Part D plans do not consider the network size. Thus, you will still need to do your own research concerning costs, coverage, and network size and availability for providers and pharmacies.

Finally, it’s important to know about the five-star Special Enrollment Period (SEP). Once per calendar year, you may enroll or switch to a five-star Medicare Advantage or Part D. This type of SEP begins on December 8th of the year before the plan gets a five-star rating and ends on November 30th of the following year, giving you almost 12 months to make the change.

The Bottom Line

Medicare Plan Star Ratings are an important consideration when choosing a Medicare Advantage or Part D plan. You should always take the star ratings into account, though you shouldn’t only focus on star ratings. Instead, you should look at star ratings, costs, coverage, networks, and any other aspects of the plan that could have an impact on your experience.

If you’d like to learn more about Medicare Plan Star Ratings or your Medicare coverage options, feel free to fill out this form or give us a call anytime. Time for 65’s partnered licensed agents are focused on giving you the information you need, with zero pressure to enroll in a plan.