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How are Medicare Advantage Plans Rated by the Government?

Medicare Part C VS Original Medicare

As a branch of the government, Medicare rates plans for their effectiveness for members, but many other factors go into rating Medicare Advantage plans. You can find and compare plans based on rating using Medicare.gov Plan Quality and Performance Ratings tool. Medicare uses various information like member satisfaction surveys, plan quality, health care provider reviews and other facts to give overall performance star ratings. The ratings allow you to compare different plans based on their quality and performance. Plans are rated from one to five stars. If a plan has a five-star rating, it’s considered the absolute best for Medicare Advantage plans.

What Do These Ratings Mean?

There are a range of topics for which Medicare Advantage plans are rated. These include:

Prescription drug plans or Part D plans are rated separately if not included in the Medicare Advantage plan. These are rated for the following:

If a plan has both health and drug coverage, then the overall score is for both.

What is the 5-Star Special Enrollment Period?

The 5-star special enrollment period allows anyone to switch to a 5-star Medicare Advantage plan. These plans may include just health coverage, a combination of health and drug coverage or just drug coverage. You are allowed to use the 5-star special enrollment period one time starting on December 8th and ending on November 30th of the following year. However, this depends on you meeting the plan’s enrollment requirements. You have to live within the service area for the plan, meet requirements regarding age or being eligible based on disability.

If you want to switch to a different plan but already have a 5-star enrollment rating, you can also do so at this time. You can also use the Special Enrollment Period to remove yourself from a Medicare Advantage Plan or Medicare Part D plan to go into an open Medicare Cost Plan with a 5-star rating. This is a type of HMO plan now available to those who are eligible for Medicare.

these plans work in the same way as Medicare Advantage and have the same rules as Medicare Advantage, but if you go to non-network provider, you can still receive coverage under Original Medicare.

Is It Worth the Wait?

Plans with a higher rating are more satisfactory to members, but ratings also take into account the quality of care and prescription drug coverage that members are receiving. Typically, there are only one or two plans per state that have a 5-star Medicare Advantage plan rating. These plans may have more extras and provide comprehensive coverage for other services not covered by other Medicare Part C plans.

In addition, you may lose prescription drug coverage if you switch from a Medicare Advantage plan that has drug coverage to a plan with a high rating but that does not have Part D. You will have to wait until the Open Enrollment period to add drug coverage. In this case, you would also pay a late enrollment penalty.

If you decided to move to a coordinated care plan that is not Medicare Advantage, you will lose any extras and drug coverage that came with the Medicare Advantage plan. In this event, your coverage goes back to Original Medicare.

To make sure that you pick the best plan, you should always compare different plan costs and benefits while also looking at the reviews for different companies offering Medicare Advantage plans in your area. In some cases, companies may still have bad reviews even if a plan has a higher star quality rating.

Understanding Ratings and Special Enrollment

Scenario #1
When Does a Plan Receive a 5-Star Rating?
The ABC Medicare Advantage Plan got an overall rating of 4.5 stars in 2013 but received 5 stars for 2014. Starting on December 8th, 2013, you could have used the Special Enrollment Period to enroll in the 5-star ABC Medicare Advantage Plan that became effective on the first day of January 2014. The plan didn’t have a 5-star rating until 2014, which means that you had to wait until the Special Enrollment period for that year to start.

Scenario #2
When Plan Ratings Change
ABC Medicare Advantage Plan had a rating of 5 stars in 2014 but lost the 5-star rating for 2015. You could use the 5-star Special Enrollment Period to request enrollment in the ABC plan before the first day of the next month until November 30th, 2014. The last effective date is December 1st, 2014. You won’t be able to use the special enrollment period after the first day of December since the plan will no longer have a 5-star rating.

Comparing Plans With Ratings

To compare plans with ratings, you can use tools on Medicare.gov, but MedicarePartC.com also has comparison tools and other guides to help you pick the best plans. You can search for plans in your area and pick plans based on rating, cost and benefits. It’s easy to see what plan offers the best benefits for the price. When you search for plans directly on Medicare.gov, each will provide an “overall star rating” that will give you insight into how that plan compares to other similar plans. Some plans do not have an overall rating yet, which may mean they are not offering the same amount of services as other plans. Some of the highest rated Medicare Advantage plans come from:

If you are looking for a high quality Medicare Advantage plan, you should look first at the monthly premium and deductible, then look at the specific health benefits for each plan to compare. Most plans should designate what the out-of-pocket costs will be as well as what type of relationship you’ll have with doctors and medical facilities. In some cases, you will be able to pick your own doctors and facilities. Some plans also include extras like vision and dental yet still have a very low or no cost per month. If you need help picking a plan that’s best for you, contact our staff to get help fast at 1-888-228-MEDI.


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