When you examine your Medicare plan options during this year’s open enrollment season, do not judge a Medicare Advantage plan by its stars. The government’s star-rating system is deeply flawed. Rather, you should assume that some plans with four and five-star ratings have high denial and mortality rates and low-quality provider networks.
For sure, you should avoid Medicare Advantage plans with one and two-star ratings. They are few and far between. And, if the Centers for Medicare and Medicaid Services is giving them such a low rating, there’s a reason.
But, the higher star-ratings are based on measures that can be extremely misleading. For one, the star ratings are determined on an insurer’s group of Medicare Advantage plans, at the Medicare Advantage “contract level.” If there’s a Medicare Advantage plan that’s performing poorly that is assessed with others that are performing better, that poor-performing Medicare Advantage plan will reap the star-rating of its fellow plans. And, people who join that poor-performing plan will have no clue.
MedPac has proposed changing the star-rating program, which it says is “flawed.” It is “inconsistent with the [MedPac] Commission’s principles for quality measurement.” In addition to giving plans ratings based at the “contract level” and not the individual plan level, the Centers for Medicare and Medicaid Services (CMS) does not focus on population-based outcome and patient experience measures. In addition, plans are rated as compared with one another, not relative to objective performance targets. And, plans are not rated by subpopulations served, so there’s no way to know if a plan with a high rating is actually meeting the needs of its members with special needs and costly conditions.
Another issue with the star-rating system is that it is not budget neutral. The more plans with four- and five-star ratings, the higher their payments. This means that Medicare Advantage plans are not operating on a level playing field with traditional Medicare.
How should you choose a Medicare plan? If you want easy access to care from your choice of doctors anywhere in the US and few if any out-of-pocket costs, traditional Medicare is your best option. But, you will need supplemental coverage—Medigap, retiree coverage or Medicaid—to protect yourself financially. To choose a Medicare Advantage plan, talk to your doctor. Pick a plan that has the doctors you want to see and hospital you want to use in its network. And, keep in mind that if you need costly health care services, your out-of-pocket costs could easily be $5,000 for in-network care alone.
Fierce Healthcare reports that, in 2022, almost seven in ten Medicare Advantage plans have a four-star or five-star rating. That’s up from not even five in ten in 2021.
Here’s more from Just Care:
- Traditional Medicare offers better home care benefits than Medicare Advantage
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
- Well-kept secrets of Medicare Advantage plans
- Don’t trust Medicare’s Open Enrollment information
- High proportion of people flee Medicare Advantage at end of life
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