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Dear Matt!

I saw somewhere online the 2022 Medicare Star Ratings were released.  I want a highly rated plan.  How do I find out what Star Rating my plan got?  Should I even care about this? 

Craig S.

Thanks for the question, Craig!

Medicare Advantage Part D Prescription Drug Plans

On October 8 of this year, Medicare distributed a press release outlining the Medicare Advantage and Medicare Part D Prescription Drug Plans that were awarded the coveted five-star rating. In chapter two of my book, Prepare for Medicare – The Insider’s Guide to Buying Medicare Insurance (2021-2022 Edition), I give an in-depth look into the Medicare star rating system.

There’s an updated link on my website that outlines all of the plans Medicare awarded five and four and a half stars for 2022, and you can find that by clicking here. The article attaches a nice grid at the bottom showing all the plans, and they’re listed under four headings: Contract Name, Organization Marketing Name, Parent Organization, and 2022 Overall (Star Rating). This year, 73 specific Medicare health insurance policies were awarded five stars.

Notice I said Medicare health insurance policies. That’s an important distinction to make. When a Medicare insurance company has a five-star plan listed, it doesn’t mean that all plans carry the five-star designation. It just means one particular plan they offer has received the distinction. The ones listed in the Contract Name are the only ones that have received the award. The contract name (outlined below) usually gives it away; you’ll notice many state-based contracts.

You’ll find the Parent Organization Tab includes some of the usual suspects. You’ll see larger, national Medicare insurance plan companies like Aetna, Humana, Centene, and United Healthcare. You’ll also see some smaller, regional companies like Kaiser Foundation Health Plan, Intermountain Health, Ucare, Essence Healthcare, and HealthPartners, though that is not an exhaustive list. This shows there are many smaller, regional Medicare insurance companies out there that put out high-quality Medicare insurance products right alongside the larger national Medicare insurance companies!

What is the Medicare Star Rating System?

The Medicare star rating system is the federal government’s attempt to tap into a consumer-friendly five-star rating system concept. This star rating system only applies to Medicare Advantage and Medicare Part D Prescription Drug Plans. Medicare Supplement plans are excluded.

The Medicare Star Rating System is numbered from one to five, with five being the best and one being the lowest in terms of quality of service. To determine these ratings, Medicare Advantage plans are judged in five different categories: The first is “Staying Healthy,” which concerns screenings, tests, and vaccines. The second is “Managing Chronic (long-term) Conditions,” and the third is responsiveness and care. The fourth is member complaints, problems getting services, and leaving the plan. The final category is customer service.

Medicare Part D Prescription Drug Plans are rated in four different categories: drug plan customer service, member complaints (which include problems getting services and choosing to leave the plan), member experience with the drug plan, and finally, drug pricing and patient safety.

Why You Should Care About Medicare Star Ratings

Five-star plans get a Special Enrollment Period and can enroll Medicare consumers outside of the standard Annual Election Period (October 15 to December 7) and Open Enrollment Period (OEP) windows (January 1 to March 31). 

The Special Enrollment Plan can only be used once between December 8 and November 30; you can switch to a five-star plan outside regular enrollment and election windows. Five-star plans get to play by different rules.

Second, and probably more importantly for you, if your plan is rated three stars or below, you’ll pay more money for your policy, or your benefits won’t be as rich as plans with four or more stars. This is because Medicare insurance companies get bonuses and rebates from the federal government for higher star ratings. When they get this bonus money, they have to spend much of it to improve the insurance benefits or lower the monthly premiums for the Medicare insurance plan. So, if you have a five-star rated plan, odds are you have better benefits available to you than other, lower-rated plans.

Hope that helps, Craig!

I love answering Medicare questions. Send me yours at questions@prepareformedicare.com, and I’ll pick a few for a future blog post!

To your wealth, wisdom, and wellness!

-Matt Feret

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Author Bio Matt Feret is the author of the Prepare for Medicare book series and launched prepareformedicare.com to help people get objective answers to questions about Medicare. Matt is also the host of The Matt Feret Show. He has held leadership roles at numerous Fortune 500 Medicare health insurers in sales, marketing, operations, product development, and strategy for over two decades.