Medicare Advantage plan star ratings have always been a farce, and you should not trust them. Most Medicare Advantage plans have four or five stars, and they still might offer poor quality care. Because of a change in the way the government weights different metrics, Medicare Advantage star ratings are falling a bit, reports Axios.
In 2023, 57 health insurers will offer Medicare Advantage plans with five-star ratings. This year, 74 health insurers offer Medicare Advantage plans with five-star ratings. The ratings are supposed to be based on quality measures, including consumer assessments, but the question is what goes into those measures and how are they weighted.
The government looks at how well the Medicare Advantage plans do at customer service, as well as keeping members healthy through preventive services and management of chronic conditions. The government also looks at member complaints. The Centers for Medicare and Medicaid Services (CMS) audits the data the Medicare Advantage plans report. But, Medicare Advantage plans can game the system to achieve higher ratings.
In fact, the federal government has never been able to assess the quality of care Medicare Advantage plans offer, overall, let alone individually. The Medicare Payment Advisory Commission (MedPac) repeatedly has said in its reports on Medicare Advantage that the health plans fail to disclose complete and accurate data, as required by law, to enable proper assessment of plan quality. Four and five-star rated Medicare Advantage plans could deliver poor health outcomes or otherwise jeopardize patient care, which might not be captured in the data CMS collects.
For sure, there is star-rating inflation. The average rating for all Medicare Advantage plans is more than four stars, 4.15 out of 5 stars. That’s down from 4.37 stars in 2022. Some plans, such as those offered by CVS Health and Centene, saw a big drop in star ratings and are now restricted in their ability to grow their enrollment. But, it does not appear that the the government notifies people already enrolled in those plans, let alone suggests they disenroll from them.
During the upcoming open enrollment season, if you opt for Medicare Advantage over traditional Medicare, don’t choose a Medicare Advantage plan by its stars or by the extra benefits they offer (which often are not what they appear to be.) Talk to your doctors and friends in the health plans you are considering, particularly people who have needed a lot of costly care. Find out whether they believe they have gotten the care they needed, without undue delays, and what they had to pay out of pocket.
During the pandemic, star ratings were weighted less heavily towards consumer satisfaction. Now, CMS is relying more heavily on patient survey data for its ratings, which is affecting ratings for some plans.
While consumer data only captures one aspect of quality, all Medicare Advantage plans are different in multiple ways. People in some plans face higher rates of delays and denials of care than in other plans. Several expert studies also show that many Medicare Advantage plans have disproportionate rates of disenrollment by people with costly and complex conditions.
Medicare Advantage plans with lower star-ratings get less money from the government for their services, which could affect the benefits they offer and shift more costs onto their enrollees.
Here’s more from Just Care:
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
- Ten ways to improve Medicare Advantage
- Medicare ratings of Medicare Advantage plans a farce
- Medicare Annual Open Enrollment: Beware of Bad Actors
- Medicare Advantage plans are an “Insatiable Cash Monster“
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