How to Use Medicare Plan Ratings
Medicare rates the quality of Medicare Advantage plans, which cover hospitalization, outpatient care, and, often, prescription-drug coverage. It also rates Part D drug plans, which help to pay for the cost of prescription medications.
So when you’re thinking about adding coverage to traditional Medicare, consider Medicare’s ratings as you compare health plans. The ratings are updated every fall. And the more stars a plan has, the higher the rating.
Check Plan Ratings Online or by Phone
Medicare’s Plan Finder lets you search for health plans in your area and see how they're rated. You can compare up to three plans at a time. Or you can call 800-MEDICARE (1-800-633-4227) to get a plan’s ratings.
5 Ways to Use Medicare’s Ratings to Pick a Plan
Look for a plan with a gold star by its name. That means it has the highest rating. If a plan with 5 stars isn’t available where you live, be sure to select one with at least 3.5 stars.
Break a tie between plans. If you’re comparing plans that are similar in costs and coverage, you can identify and choose the one with a better quality rating.
Swap your plan for a better-rated one. You can switch to a five-star plan once a year between Dec. 8 and Nov. 30.
Find the best plan for managing your chronic condition. Each plan gets an overall score for managing chronic conditions. There are also individual scores for some conditions, such as diabetes, high blood pressure, osteoporosis, pain management, and rheumatoid arthritis.
- Get a sense of what it's like using the plan. Check a plan’s ratings on how many member complaints they get or how long it takes to get an appointment with an in-network doctor. Look at their rating for member satisfaction.
What the Ratings Mean
Here's what the ratings mean:
- Five stars is excellent.
- Four stars is above average.
- Three stars is average.
- Two stars is below average.
- One star is poor.
If a plan has no rating, it's new. Or there might not be enough information for a rating to be done.
A plan’s service-specific rating -- Besides the overall rating, you can check how each plan rates for a specific type of care. Service-specific ratings use the same one-to-five scale. For instance, you might be interested in a plan's rating on screening for colon cancer, how plans rate on their speed setting up appointments, or how long you have to wait for care.