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 for people not enrolled in a Medicare Advantage plan.
So when you’re considering a new Medicare plan, it’s a good idea to review Medicare’s ratings to compare health plans. The ratings are updated every fall. And the more stars, 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 (5 stars). 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. Consider, of course, what you will need in a plan.
- Swap your plan for a better-rated one. You can enroll in a plan or switch your plan once a year between October 15 and December 7. If you’re already enrolled in a plan you have an additional period between January 1 and March 31 to change plans or return to Original Medicare.
- 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-specificrating. 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 flu vaccines, how plans 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 as well as required data reporting from the health plan. Medicare also uses information from health care providers.
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.