Medicare Your Coverage Options

Medicare ratings of Medicare Advantage plans a farce

Back in January 2016, the Centers for Medicare and Medicaid Services sanctioned Cigna for threatening the health and safety of its members in Medicare Advantage plans. But, notwithstanding Cigna’s sanction and “its longstanding history of noncompliance with CMS requirements,” a new CMS policy allows Cigna to retain its multi-star ratings, making Medicare ratings of Medicare Advantage plans a farce.

The sanctions against Cigna precluded Cigna from enrolling new Medicare Advantage members or marketing its plans to prospective members. According to CMS, “Cigna’s conduct poses a serious threat to the health and safety of Medicare beneficiaries.” But, the new CMS policy means that Cigna is still eligible to receive hundreds of millions of dollars in financial rewards from Medicare.

And, because the new policy allows Cigna to keep its multi-star ratings, the star ratings also mislead people who are looking at Medicare’s star ratings as they consider whether to join a Medicare Advantage plan. Medicare star ratings are supposed to indicate a health plan’s performance, including the quality of its care. But, CMS reports that Cigna has delayed and denied its members access to medical services and prescription drugs as well as increased their members’ out-of-pocket costs for care in violation of CMS requirements.

Earlier this month, MedPAC, the independent commission that oversees Medicare, found that the Medicare Advantage star ratings do not help people with Medicare for yet another reason. They do not allow you to compare individual Medicare Advantage plans in a given community. CMS grants health plans stars at “the contract level,” meaning that they are granted to an insurance company for a bunch of their Medicare Advantage plans, not to individual plans. Consequently, a Medicare Advantage plan that performs poorly can still get a five-star rating if an insurer packages it with better performing plans.

Think carefully, when choosing a Medicare health plan and follow these tips:

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