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 2022, the average Medicare Advantage plan with integrated Part D coverage (MA-PD) received 4.37 stars, up from 4.06 stars in 2021 (average is weighted by enrollment). And the average stand-alone Part D plan received 3.7 stars (up from 3.58 in 2021). CMS reported that approximately 90% of MA-PD enrollees are in plans that have received at least four stars for 2022.
Which Medicare plans received 5-star ratings for 2022?
For 2022, there are a total of 87 Medicare contracts nationwide that have a 5-star rating (a significant increase from the 28 Medicare contracts that had 5-star ratings in 2021). Three are Medicare cost plans and 74 are Medicare Advantage plans with integrated Part D coverage. The other ten are stand-alone Part D plans, but they’re only available as employer group plans, and cannot be purchased by individuals (see Table A3 here for details). Of the 87 contracts that received five stars for 2022, there were 60 that had lower ratings in 2021.
CMS noted that although some changes had been made to the rating system for 2022 to account for the COVID pandemic, the sharp increase in the number of contracts with 5-star ratings “also reflects improvements in sponsors’ scores on several measures.”
The following contracts have 5-star ratings for 2022 (note that plan availability is limited to only certain counties within a given state, and refers to availability for individuals to purchase on their own; many of these plans also offer an EGWP option for employers to purchase as an employer-sponsored health benefit):
5-Star Medicare Advantage plans with Part D coverage
- Viva Health, Inc. (Alabama)
- UnitedHealthcare of the Midwest (Iowa, Kansas, Missouri, Nebraska)
- Humana Health Plan of Ohio (Kentucky)
- Care Improvement Plus Wisconsin Insurance Company (Michigan, Wisconsin)
- KS Plan Administrators, LLC (Texas)
- Kaiser Foundation Health Plan (California)
- Kaiser Foundation Health Plan of Colorado (Colorado)
- Sierra Health and Life Insurance Company (29 states)
- CarePlus Health Plans Inc. (Florida)
- Kaiser Foundation Health Plan of Georgia (Georgia)
- Kaiser Foundation Health Plan (Hawaii)
- Martin’s Point Generations Advantage Inc. (Maine, New Hampshire)
- Care Improvement Plus South Central Insurance Company (nationwide)
- Humana Health Benefit Plan of Louisiana (Louisiana)
- People’s Health Inc. (Louisiana)
- SelectHealth Inc. (Idaho, Nevada, Utah)
- Sierra Health and Life Insurance Company (Maine, Utah)
- Kaiser Foundation Health Plan of the Mid-Atlantic (District of Columbia, Maryland, and Virginia)
- Commonwealth Care Alliance, Inc. (Massachusetts)
- UnitedHealthcare Insurance Company (Massachusetts)
- Baycare Select Health Plans Inc. (Florida)
- Tufts Associated HMO (Massachusetts)
- Oxford Health Insurance Inc. (New York)
- Prime West Rural Minnesota Health Care Access Initiative (Minnesota)
- South Country Health Alliance (Minnesota)
- Health Partners Inc. (Minnesota)
- Blue Plus (Minnesota)
- UCare Minnesota (Minnesota)
- Group Health Plan Inc. (Minnesota, North Dakota, South Dakota, Wisconsin)
- Essence Healthcare Inc. (Illinois, Missouri)
- Independent Health Benefits Corporation (New York)
- Excellus Health Plan Inc. (New York)
- Independent Health Association Inc. (New York)
- Capital District Physicians’ Health Plan Inc. (New York)
- Health Partners Unitypoint Health (Iowa, Illinois)
- Blue Cross and Blue Shield of Rhode Island (Rhode Island)
- Aetna Health Inc. (Maine)
- Aultcare Health Insuring Corporation (Ohio)
- Care Improvement Plus Wisconsin Insurance Company (Wisconsin)
- UPMC Health Plan Inc (Ohio, Pennsylvania)
- Highmark Senior Health Company (Pennsylvania)
- Keystone Health Plan East (Pennsylvania)
- Highmark Choice Company (Pennsylvania)
- Blue Cross Blue Shield of Rhode Island (separate contract; Rhode Island)
- NHC Advantage LLC (Missouri, South Carolina, Tennessee)
- Cariten Health Plan Inc. (Tennessee)
- Medical Mutual of Ohio (Ohio)
- UnitedHealthcare Benefits of Texas Inc. (Texas)
- Health Partners Inc (Minnesota, Wisconsin)
- Asuris Northwest Health (Washington)
- CDPHP Universal Benefits Inc. (New York)
- Kaiser Foundation Health Plan of Washington (Washington)
- Wellcare of California Inc. (California)
- My Choice Wisconsin Health Plan Inc. (Wisconsin)
- Network Health Insurance Corporation (Wisconsin)
- UnitedHealthcare of Wisconsin Inc. (Arizona, Iowa, Illinois, Kentucky, North Carolina, Ohio, Tennessee, Virginia, Wisconsin)
- Quartz Health Plan Corporation (Iowa, Illinois, Wisconsin)
- Sharp Health Plan (California)
- Healthspring of Florida Inc. (Florida)
- Medica Healthcare Plans Inc. (Florida)
- HealthSun Health Plans Inc. (Florida)
- HealthAssurance Pennsylvania Inc. (Pennsylvania)
- Highmark Western and Northeastern Inc. (New York)
- UPMC Health Network Inc. (Pennsylvania)
- Martin’s Point Generations Advantage Inc. (separate contract; Maine, New Hampshire)
- Optimum Healthcare Inc. (Florida)
- Sierra Health and Life Insurance Company (Colorado, Florida, Kansas, Massachusetts, Maryland, Michigan, North Carolina, New Jersey, Pennsylvania, Texas, Virginia)
- Blue Care Network of Michigan (Michigan)
- Capital Health Plan (Florida)
- Kaiser Foundation HP of the Northwest (Oregon, Washington)
- Providence Health Assurance (Oregon, Washington)
- Dean Health Plan Inc. (Wisconsin)
- Care N’ Care Insurance Company of North Carolina (North Carolina)
- Quartz Health Plan Minnesota Corporation (Minnesota)
5-Star Medicare cost plans
- Medical Associates Health Plan (Iowa, Illinois)
- Dean Health Plan (Wisconsin)
- Medical Associates Clinic Health Plan (Wisconsin)
5-Star Stand-alone Part D plans
All ten of the five-star Part D plans are employer group health plans, and are not available for individuals to purchase on their own:
- PSERS-HOP Program
- MVP Health Plan Inc.
- Tufts Insurance Co.
- HealthPartners Inc.
- Excellus Health Plan Inc.
- Health Alliance Medical Plans
- Independent Health Benefits Corporation
- Moda Health Plan Inc.
- QCC Insurance Company
- Dean Health Insurance Inc.
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 although the majority of Medicare Advantage plans (and many stand-alone Part D plans) receive at least four stars, there are still relatively few that receive five stars. For 2022, there are a total of 77 Medicare plans — available for individual consumers — that received five stars, out of thousands of Medicare Advantage and Part D plans nationwide.
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.
And for the 2022 ratings, CMS implemented some changes to essentially ensure that a contract’s rating would not decrease due to the pandemic. This is part of the reason that the number of 5-star plans grew so much for 2022, but CMS also noted that many plans simply performed better on other metrics as well.