Robert King writes for Fierce Healthcare about a change to Medicare’s star-rating system for Medicare Advantage plans. As a result of Medicare’s change to its star-rating system, a new analysis finds that the overwhelming majority of Medicare Advantage plans will face lower star-ratings.
For some time now, the federal government has tried–unsuccessfully–to help people distinguish among Medicare Advantage plans–corporate health insurance plans that are paid to cover Medicare benefits. Medicare Advantage plans are an alternative to traditional Medicare, which is public health insurance that covers your care from most doctors and hospitals across the US and is administered directly by the federal government.
The government uses a “star-rating” system to help people distinguish among Medicare Advantage plans. But, the stars the government gives Medicare Advantage plans are no way to gauge whether a Medicare Advantage plan will cover your care from physicians you trust when you need it. From the perspective of people with Medicare, the stars are a farce because the Medicare Advantage plans have been able to game them and they do not measure key differentials among Medicare Advantage plans. For example, the star-rating system does not factor mortality rates in different Medicare Advantage plans and rates of inappropriate delays and denials of care.
The Centers for Medicare and Medicaid Services (CMS), the agency that oversees Medicare, is now raising the bar for getting stars in 2023. It will be giving double the weight it has to customer service, accessing prescription drugs, care coordination and health care quality.
Under this new way of calculating star-ratings, nearly 50 percent of Medicare Advantage plans would lose one star. The loss of a star speaks to the difficulty that enrollees are increasingly facing getting prescription drugs in their Medicare Advantage plans. More Medicare Advantage enrollees are unsatisfied with their ability to fill their prescriptions at a reasonable out-of-pocket cost.
From the Medicare Advantage plans’ perspective, losing a star or two means loss of significant revenues, often millions and sometimes billions of dollars. Without that money, Medicare Advantage plans might not be willing to offer as generous benefits. It will also be harder for them to retain enrollees.
More than four in ten (44 percent) Medicare Advantage plans could lose a star because their enrollees are less satisfied with customer service and care coordination.
Press Ganey performed the analysis in early 2022, based on data from 446 Medicare Advantage plans.
Since 2015, Medicare Advantage plan quality bonuses have nearly quadrupled, from $3 billion to $11.6 billion. Part of the increase is attributable to the government awarding bonuses to more Medicare Advantage plans. Part of the increase is attributable to the number of enrollees in the Medicare Advantage plans that received bonuses.
Here’s more from Just Care
- Evidence abounds that Medicare Advantage needs an overhaul
- Don’t judge a Medicare Advantage plan by its stars
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
- OIG finds widespread inappropriate care denials in Medicare Advantage
- If you want easy health care access and good quality care, you probably want traditional Medicare
Many claims, unfavorable, are made here. This is a difficult and often confusing subject for many. Start with basic terminology, explain what Medicare Advantage Plans are and how they differ or supplement Medicare. Is there something called “traditional Medicare?” I have Medicare and a Medicare Advantage Plan, which is required by my retirement system ( which is not Social Security).
Start with basic introductory info on this complex matter and proceed from there. We old people don’t need further terrorizing, but rather basic, understandable information!
This is indeed a difficult and confusing subject, Dave. Thank you for getting me to revise the post to be a bit clearer. I hope my edits help.