It’s Medicare Open Enrollment season. If you are trying to decide among Medicare Advantage plans, don’t be misled by the star ratings. The government should do away with them, along with bonuses to Medicare Advantage insurers who get four and five stars. The government does not and cannot at the moment measure quality in Medicare Advantage plans, although the star ratings would suggest otherwise.
The star ratings have nothing to do with whether you’ll get the care you need in a given Medicare Advantage plan. For one, CMS does not consider Medicare Advantage plan-level data when it gives out its star ratings. Yet, each Medicare Advantage plan is different, some with far higher denial rates and worse health outcomes than others.
The government calculates star ratings at the insurer “contract” level, merging data from a multitude of plans, sometimes in different states, always with different networks and denial rates. Moreover, the star ratings don’t even attempt to capture the best measures for whether the Medicare Advantage plan you enroll in will cover the care you need–health outcomes and denial rates.
Bottom line: Enrolling in a Medicare Advantage plan is always going to mean gambling with your health. You can and should avoid the one, two and three-star Medicare Advantage plans. But, unfortunately, the four and five-star plans could have high rates of inappropriate denials, delay care needlessly and have inadequate provider networks. In short, they might offer poor quality care. And, there’s no knowing ahead of time.
Adding insult to injury, you can’t even avoid the plans that should be receiving one, two and three stars. When insurers receive low ratings, they challenge those ratings in court because it can mean a huge revenue loss; and they often prevail. CVS is the latest insurer challenging its star ratings in court, to reclaim $2 billion dollars in bonus payments from the government. Alignment Healthcare, Healthfirst, SCAN Health Plan and Centene have also filed challenges. Each claims that particular measures that reduce their ratings are illegal. Historically, the insurers generally prevail.
Here’s more from Just Care:
- Administration weakens Medicare Advantage star-rating system, boosting insurer payments
- One health insurer admits that Medicare Advantage is broken
- 2027: Five things to think about when choosing between traditional Medicare and Medicare Advantage
- Whistleblower says CVS won’t cover some low-cost generics
- Medicare Advantage: Denials and more denials, some deadly
