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 as well as whether the plan has improved in the past 2 years
- The plan’s customer service
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 satisfaction with the plan, others less so. The ratings do not take into account whether the plan includes high-quality hospitals and doctors in its network.