2019 Medicare Star Rating Low Performers – The Good, The Bad and The Ugly

2019 Star Ratings PDP MAPD

2019 Low Performing Medicare Advantage Plans

On October 10, 2019 Medicare released updated Star Ratings for 2019 Medicare Advantage (MAPD) and Prescription Drug (PDP) Plans.  Star ratings are very important to health plans, both because they are tied to bonuses they receive from CMS, and because they make a difference to consumers when choosing a plan.  Plans are measured by a Part D (drug) and a Part C (medical) score.  Both combine to equal an overall plan score.  While the overall Star Rating is important, having a low score (2.5 or below) in one of those categories can spell trouble for a plan.  Below, you’ll find a list of companies who are offering Medicare Advantage plans who scored a 2.5 rating or below on at least one of the two categories.

Some Medicare plans with consistently low Star Ratings will show a “low performing plan” indicator on Medicare’s own website!  It looks like an upside-down triangle with an exclamation point, and often limits enrollment from the Medicare website.  In fact, people who are on plans that get this “low performing plan” status get letters in the mail from Medicare, informing them of the performance of the company.  Not good, if you’re an insurance company – and not good if you’re on that plan!

2019 Medicare Star Ratings Overview

For 2019, approximately 74 percent of Medicare Advantage enrollees with prescription drug coverage are projected to be in plans with four and five stars in 2019 as compared to 73 percent in 2018. About 45 percent of Medicare Advantage plans that offer prescription drug coverage will have an overall rating of four stars or higher in 2019.

Each Medicare Advantage plan is rated across five broad quality metrics, including Staying Healthy, Managing Chronic Conditions, Member Experience with Health Plan, Complaints and Changes in Plans Performance, and Health Plan Customer Service, Drug Plan Customer Service, Complaints and Changes in the Drug Plan, Member Experience with the Drug, Drug Safety and Accuracy of Drug Pricing.

Enrollees in stand-alone Medicare Part D prescription drug plans will also have access to high-quality plans. In 2019, approximately 31 percent of stand-alone prescription drug plans will have a rating of four stars or higher in 2019.

The Good

Kaiser Permanente had four MA health plans earn a five-star rating, which was the most of five-star plans offered by a single payer.

Two Humana plans earned a five-star rating, while Cigna made it onto the list with its HealthSpring of Florida plan. Anthem had one MA plan earn a five-star rating while a joint Anthem-BlueCross BlueShield plan also earned five stars.

The Bad

However, fewer plans earned a five star overall rating than in 2018. Twenty-four plans earned a five-star rating in 2018 while only 21 earned the same rating in 2019.

Overall quality remains high, though, as CMS only identified four Medicare Advantage plans that earned an overall 2.5 stars or lower in the overall performance rating. Remember from above, that’s 2.5 stars or lower with a combined score.

The Ugly

However, many companies and plans scored a 2.5 rating or lower in at least one of either the Part D or Part C category. Those plans are from the following companies:

  • WellCare
  • Health Alliance Medicare/The Carle Foundation
  • Amerigroup/Anthem
  • Molina Healthcare of Wisconsin
  • Community Care Alliance of Illinois/Family Health Network
  • Presbyterian Healthcare Services (New Mexico)
  • Security Health Plan of Wisconsin
  • Banner – University Care Advantage (Arizona)
  • Anthem Blue Cross and Blue Shield (various)
  • United Healthcare/AARP plans (various)
  • Steward Healthchoice Generations
  • Amerigroup Community Care of New Mexico,
  • Aloha Care
  • CareSource
  • Centers Plan for Healthy Living
  • Allwell (Centene)
  • Prominence Health Plan
  • Blue Cross Blue Shield of Texas
  • Horizon Blue Cross Blue Shield of New Jersey
  • Moda Health Plan
  • Blue Cross Blue Shield of New Mexico
  • Molina Healthcare of New Mexico
  • West Virginia Senior Advantage
  • Gateway Health Medicare Assured
  • Eon Health
  • Passport Advantage Kentucky (University Healthcare, Inc.)
  • Humana (various)

The Takeaway:

Having a Star Ratings score of 2.5 in any category is an immediate red flag for consumers that something is not being managed well by the parent company.  It doesn’t mean you need to immediately jump ship, but it may be a good idea to shop around to see if you’ve got other options in your hometown.  Talk to your insurance agent, or go online to medicare.gov, type in your ZIP code and take a peek around.  Odds are, you’ll have plenty of options to consider.

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Author Bio: Ben started Prepare for Medicare in 2014 to help people help people get objective answers to questions about Medicare. He’s held leadership roles at numerous Fortune 500 Medicare health insurers in product development, sales, marketing and strategy for over 20 years.