You always want to examine all the details when shopping for a Medicare Advantage policy. There are networks, prescriptions, cost-sharing and plans ratings to consider among other important items.
The Centers for Medicare & Medicaid Services (CMS) help by using an annual ratings system. The rankings are 1-5 stars with Five Stars being the best. And if there are 5 Star plans offered in your area, CMS provides unique enrollment opportunities that are not otherwise available.
How Does The Medicare Rating System Work?
First a little background: Star Ratings only apply to Medicare Advantage, Part D and Cost plans. And rankings are not always based on a full Star. It’s common to see plans with 3 1/2 or 4 1/2 Stars. New Medicare insurance plans may have no rating at all. Usually a year is needed before CMS can provide this metric.
Star Ratings typically come out once a year and in the fall. They apply to plans offered the following year. Information from members, health care providers and the insurance plans themselves all influence plan rankings.
The system is designed to help consumers evaluate the quality of care, customer service and the overall performance of various policies. Health outcomes and consumer experiences go a long way in determining rank. A plan with many complaints will not rank well.
Note: Star rankings do not apply to Medicare Supplement insurance policies. There is no formal ratings system for Supplements.
Five Star Plans Offer A Special Enrollment Window
If a Five Star Medicare Advantage, Part D or Cost plan is available in your area, you can switch from your current coverage once (and only once) between December 8th and November 30th. This nearly year long Special Enrollment Period (SEP) can be beneficial if you’re having issues with your Advantage or Part D coverage.
It’s important to know only some areas have Five Star plans available. They are designated by the county where you live. And you must be careful when switching policies. It’s easy to make a mistake. For example, a switch to a new Medicare Advantage plan might cause you to lose your Part D Drug coverage.
When in doubt, consult with an experienced broker – someone like us. You don’t want to run into monetary penalties or network issues when switching plans.
Should I Be Concerned About Three and Four Star Plans?
The short answer is no. Many comprehensive and reliable Medicare plans are ranked 3.5 – 4.5 stars. In fact, Five Star plans are somewhat rare in many parts of the country.
Even though a Medicare plan might have a high rating, it does not mean it’s the most suitable for you. There are important questions to ask, like:
- Are all of my doctors in network?
- Are my prescriptions covered?
- What are the travel benefits?
- Does it include dental, vision, hearing & gym benefits?
In other words, it’s not always wise to enroll in a Medicare Advantage plan based on Star Ratings alone. Plans are nuanced and coverage with a lower ranking might be much more appropriate overall. Some policies designed for veterans do not offer Part D drug coverage. Those might not be a good fit for you. It pays to explore all plan benefits before enrolling.
Star Ratings Also Affect Part D Drug Coverage
You might enroll in a stand alone Part D drug plan for a couple of reasons. Maybe you chose to pair one with a Medicare Supplement – or maybe your Advantage plan does not offer drug coverage. Medical Savings Accounts and PFFS plans are two examples of Advantage plans with no Part D benefits.
Whatever the case, you can compare Medicare Drug plans by star ratings as well. Almost all plans will fall in the 3-4 star area. It’s rare to find a 5 Star Medicare Part D drug plan. These policies have too many moving parts and consumers have more issues with them overall. Plans change their prices, formularies and other factors every year causing more issues for consumers.
Contact Us To Compare Your Medicare Options
There’s a lot to know when shopping for Medicare insurance policies. At Hyers and Associates, we make it easy. We’ll take the guesswork out of the process – and there are no charges whatsoever to use our services.
Whether you’re interested in moving to a 5 Star plan – or you just want to evaluate your coverage options, we can help. Contact us today!