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Health Care Reform:

Health Insurance & Affordable Care Act

How to Use Medicare Plan Ratings

Medicare rates the quality of health plans that replace traditional Medicare (Medicare Advantage, special needs plans) and that provide coverage in addition to traditional Medicare (MediGap).

So when you’re considering adding coverage to traditional Medicare, use Medicare’s ratings to compare health plans to find the best one for you.

Check Plan Ratings Online or by Phone

Medicare’s Plan Finder on their web site lets you search for health plans in your area to 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.

7 Ways to Use Medicare’s Ratings to Pick a Plan

1. Pick the best plan fast. Look for a plan with a gold star by its name. That means it has the highest rating. If there’s only one plan with a star, your decision may be made.

2. 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.

3. Quickly take low performers off your list. If a plan has an upside-down pyramid next to it, they’ve had a poor rating 3 years in a row. You don’t even have to spend time looking at it.

4. Swap your plan for a better-rated one. You can switch to a five-star plan anytime during the year. But you can only change plans once a year. Medicare will help you find a better plan if yours has gotten fewer than three stars for the past 3 years.

5. Decide if you want to stick with a less-than-five-star plan. If you like your plan, but it doesn’t have the highest quality rating, look to see if it’s improving. If it is, you might want to give it some more time. If it’s not, you might benefit from checking out a better plan.

6. 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.

7. 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. Look at their rating for member satisfaction.

What the Ratings Mean

Medicare gives one to five stars to every health plan and prescription drug plan that is part of the program. The more stars, the higher the rating. And the higher the rating, the better the quality of care. The ratings are updated every fall.

Here's what they mean:

  • Five stars is excellent.
  • Four stars is above average.
  • Three stars is average.
  • Two stars is below average.
  • One star is poor.

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