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 2021, the average Medicare Advantage plan with integrated Part D coverage (MA-PD) received 4.06 stars (average is weighted by enrollment). And the average stand-alone Part D plan received 3.58 stars. As of 2020, more than three-quarters of all Medicare Advantage enrollees were in plans that received at least four stars.
Which Medicare plans received 5-star ratings in 2021?
In 2021, there are a total of 28 Medicare contracts nationwide that have a 5-star rating. Two are Medicare cost plans, and 21 are Medicare Advantage plans with integrated Part D coverage. The other five are stand-alone Part D plans, but they’re only available as employer group plans, and cannot be purchased by individuals.
The following contracts have 5-star ratings for 2021 (note that plan availability is limited to only certain counties within a given state):
Medicare Advantage plans with Part D coverage
- Kelsey-Seybold Administrators (Texas)
- Kaiser Foundation Health Plan (California)
- Kaiser Foundation Health Plan (Colorado)
- UnitedHealth Group’s Sierra Health and Life Insurance Co. (available in most of the U.S.)
- Humana’s CarePlus Health Plans (Florida)
- Kaiser Foundation Health Plan (Georgia)
- Kaiser Foundation Health Plan (Hawaii)
- UnitedHealth Group’s Care Improvement Plus South Central Insurance Co. (New York)
- Kaiser Foundation Health Plan of the Mid-Atlantic (District of Columbia, Maryland, and Virginia)
- United Healthcare Insurance Co. (Massachusetts)
- Tufts Associated Health Maintenance Organization (Massachusetts)
- HealthPartners (Minnesota)
- Capital District Physicians’ Health Plan (New York)
- Quartz Health Plan Corporation (Iowa, Illinois, and Wisconsin)
- Cigna’s HealthSpring (Florida)
- Anthem’s HealthSun Health Plans (Florida)
- HealthNow New York (New York)
- Martin’s Point Generations Advantage (Maine and New Hampshire)
- UnitedHealth Group’s Serra Health and Life Insurance Company (Colorado, Florida, Kansas, Massachusetts, Maryland, Michigan, North Carolina, New Jersey, Pennsylvania, Texas, and Virginia)
- Kaiser Foundation HP of the Northwest (Oregon and Washington)
- Quartz Health Plan Minnesota Corporation (Minnesota)
Medicare cost plans
- Medical Associates Health Plan (Iowa, Illinois, and Nebraska)
- Dean Health Plan (Wisconsin)
Stand-alone Part D plans
All five of the five-star Part D plans are employer group health plans, and are not available for individuals to purchase on their own:
- Tufts Insurance Co.
- UPMC Health Benefit
- Excellus Health Plan
- Health Alliance Medical Plans
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 2021, only 28 contracts have five stars (and five of them are only available as employer-sponsored group plans).
How has the COVID pandemic affected Medicare star ratings?
Due to the pandemic, the federal government had to contend with the fact that a significant amount of the data used for star ratings could not be collected remotely, and that in-person data collection wasn’t feasible.
CMS decided that the normal in-person data collection process could be dangerous and potentially divert staff away from their focus on addressing the pandemic. To address this, CMS used previously collected data (from 2019) for metrics that had to use in-person data collection, and only incorporated updated data that could be collected remotely. So the 2021 star ratings were based on a combination of new and previous data.
Three insurers that saw their star ratings decline in 2021 filed a lawsuit against CMS, alleging that their star ratings would have been higher if entirely new data had been collected and used.
In June 2021, a federal judge ruled against the three plaintiff insurers. The judge decided that the approach CMS took was reasonable, given the pandemic. As the pandemic drags on, it’s not clear whether CMS will continue to suspend new in-person data collection (and use 2019 data instead), resume in-person data collection (many in-person activities that were suspended in 2020 have since resumed), or potentially work with Congress and the rulemaking process to add new data elements to the Medicare star rating process.