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Medicare star ratings

What are Medicare star ratings?

How are Medicare plans rated?

The Centers for Medicare and Medicaid Services uses a star rating system to evaluate Medicare Advantage plans and Medicare Part D plans. Plans can receive from one star (poor) to five stars (excellent), and the ratings are based on numerous measures, including factors such as customer service, how easy it is for enrollees to receive care, how well the plan does at improving or maintaining members’ physical and mental health, and how quickly the plan handles appeals – among many others. (See Tables 9, 10, and 11).

Star ratings are assigned at the contract level, rather than the plan level. Most contracts have numerous plans, but all plans under a given contract receive the same star rating. Some contracts do not receive star ratings, either because sufficient data are not available, or because the contract is too new.

For 2020, the average Medicare Advantage plan with integrated Part D coverage (MA-PD) received 4.16 stars (average is weighted by enrollment). And the average stand-alone Part D plan received 3.5 stars. As of 2019, nearly three-quarters of all Medicare Advantage enrollees were in plans that received at least four stars.

Which Medicare plans received 5-star ratings in 2020?

In 2020, there are a total of 23 Medicare contracts nationwide that have a 5-star rating, although two of those are employer-group Part D plans, so they aren’t available for individual enrollees to purchase on their own.

The following contracts have 5-star ratings for 2020 (note that plan availability is limited to only certain counties within a given state):

  • Kelsey-Seybold Administrators (Texas)
  • Kaiser Foundation Health Plan (California)
  • Kaiser Foundation Health Plan (Colorado)
  • Humana’s CarePlus Health Plans (Florida)
  • Guidewell’s Florida Blue Medicare (Florida)
  • Kaiser Foundation Health Plan (Georgia)
  • Kaiser Foundation Health Plan (Hawaii)
  • Martin’s Point Generations Advantage (Maine and New Hampshire)
  • UnitedHealth Group’s Care Improvement Plus South Central Insurance Co. (New York)
  • Kaiser Foundation Health Plan of the Mid-Atlantic States (Maryland and Virginia)
  • Kaiser Foundation Health Plan of the Mid-Atlantic States (DC, Maryland, and Virginia)
  • Tufts Associated Health Maintenance Organization (Massachusetts)
  • HealthPartners’ Group Health Plan (Minnesota, Wisconsin, South Dakota, and North Dakota)
  • CVS Health’s Aetna Health (Maine)
  • UnitedHealthcare Benefits (Texas)
  • Kaiser Foundation Health Plan (Washington)
  • Quartz Health Plan Corporation (Iowa, Illinois, Wisconsin)
  • Cigna/HealthSpring of Florida (Florida)
  • Anthem/Healthsun Health Plans (Florida)
  • Quartz Health Plan (Minnesota)
  • Medical Associates Health Plan (Iowa, Illinois, and Nebraska) — this plan is Medicare Advantage only, without Part D coverage.
  • Anthem/Blue Cross Blue Shield of Massachusetts, Rhode Island and Vermont (Part D only; plans are only available to employers)
  • Excellus Health Plan/Lifetime HealthCare (Part D only; plans are only available to employers)

If there’s a 5-star plan available in a given area, Medicare beneficiaries in that area have an opportunity to switch to that plan throughout most of the year (from December 8 through November 30). But there are very few Medicare Advantage or Part D contracts that receive five stars. As of 2020, only 23 contracts have five stars. Most are Medicare Advantage plans (two are Part D plans, but they’re offered as employer-sponsored group coverage).