Every year, millions of Medicare beneficiaries must decide which Medicare Advantage (MA) plan best serves their needs. During Medicare’s annual open enrollment period, October 15-December 7, beneficiaries can change MA plans or enroll in one for the first time. Important factors to consider include premium costs, choice of doctors and plan benefits. But there is one other important question: What is the quality rating of the plan?
Quality is important because it means better health care and the best value for your money. The MA program uses a system called Star Ratings to assess the quality of plans, awarding plans from one to five stars. These ratings are based on many factors, such as how well the plan does in keeping people healthy and preventing illness, how quickly you can get an appointment and see specialists and how the plan responds to your complaints and concerns.
By adopting a value-based purchasing approach, Medicare is sending a clear message to health plans that it will recognize and reward quality. It pays a little more to those plans that are serving beneficiaries by continually improving the quality of their clinical care and providing the most satisfactory patient experience possible. And because Medicare’s decisions often affect plan and provider behavior across the health care system, MA quality incentive payments have the potential to spread value-based reforms beyond Medicare.
Today, 65 percent of MA enrollees are in plans with 4 stars or more, compared to 17 percent in 2009. Across the nation, Alliance of Community Health Plan (ACHP) members offer Medicare beneficiaries over 30 MA options rated four stars or higher. Eight of the twelve MA plans earning five Medicare stars this year are members ACHP.
You can learn more about MA plans using the Medicare Plan Finder at www.Medicare.gov. The National Committee for Quality Assurance also evaluates quality in MA plans at www.ncqa.org.
ACHP president and CEO