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Health Care Reform:

Health Insurance & Affordable Care Act

How to Use Medicare Plan Ratings

What the Ratings Mean continued...

The plan’s overall rating. This score sums up how the plan is doing in several areas.

  • If a plan gets a five-star overall rating, it will have a gold star next to its name.
  • If a plan gets low ratings for 3 years in a row, next to its name will be an upside-down pyramid with an exclamation point.
  • 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. With each plan’s information, you can check how they rated for a specific type of care. They’re rated using the same one-to-five scale. For instance, you might be interested in their rating on screening for colon cancer, how they rate on their speed setting up appointments, or how long you have to wait for care.

What Medicare Evaluates to Rate Quality

Medicare uses information from many sources to do the ratings. This includes surveys filled out by members of a health plan. Medicare also uses information from health care providers and from the plans.

Both health plans and prescription drug plans are evaluated on:

  • How a plan helps you stay healthy
  • What experiences members have had with a plan
  • What complaints members have had, which includes problems getting care. It also includes whether the plan has improved in the past 2 years.
  • The plan’s customer service

Health plans are also evaluated on what they do to manage your chronic conditions.

Prescription drug plans are also evaluated on how well they handle patient safety, which includes whether they give accurate information on drug prices.

In general, Medicare rates plans based on member health, member complaints, receipt of recommended care, and member satisfaction. Some of the factors used to rate plans may be important to your health and happiness, others less so. The ratings do not take into account whether the plan includes high-quality hospitals and doctors in its network.

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