Shoot for the Stars When It Comes to Medicare Advantage
(NewsUSA) - By Alan Stewart, SVP, Medicare Divisional Leader, Humana - If you’re one of the nation’s 58.6 million people with Medicare, you understand the importance of selecting a health plan during the Medicare Advantage and Prescription Drug Plan Annual Election Period (AEP) -- running from Oct. 15 - Dec. 7 -since the plan you select is the plan you’ll likely have for all of the coming year.
There’s a lot to think about when looking at plan options and, fortunately, reliable resources are available to help you, like Medicare.gov and licensed insurance sales agents. Another trusted resource is the Star Ratings from the Centers for Medicare & Medicaid Services (CMS).
The Significance of the Star Ratings
The Star Ratings Program is an annual assessment using about 40 measures to rate all Medicare Advantage and Prescription Drug plans and drive health care quality improvement. One of the ways CMS determines ratings is through patient-satisfaction surveys. Medicare members receive questionnaires which aim to gather information about their health, experiences with their insurance, and the care they received from doctors and specialists. CMS takes this information, along with information submitted by the health plans on things like preventive care screenings, health condition management, and medication adherence, and calculates a rating for each plan, where one star is the lowest and five stars is the highest.
Information from these surveys helps the government and various Medicare plans identify areas that can be enhanced, while also providing information that can be used in improvement activities, public reporting and health plan accountability. Star Ratings can also be a key factor for people who have Medicare to consider as they look at Medicare plans since there are several benefits to choosing a 4 or 5-star rated plan for healthcare coverage. Importantly, it provides insights into the strengths and weaknesses of plans based on the experiences shared from other Medicare members and physicians. Higher rated plans often include additional benefits, like dental, vision, and hearing coverage, and offer reduced premiums, co-pays, or deductibles.
What You Should Consider
While you are looking at plan options to identify the best plan for your health needs, you may want to take into account the Star Ratings available on CMS.gov. Licensed sales agents can also provide the plan options in your area, answer your questions, and advise on the Star Ratings.
While seeing what the ratings are this year, it’s also important to look at previous years’ scores to see how plans may have improved. For example, Humana received a 5 out of 5-star rating for three of its contracts for 2023 --which include HMO plans in Louisiana, Tennessee and Kentucky -- 96 percent of the company’s Medicare members are in plans rated 4 stars and above for 2023. This is a testament to the company’s focus on ensuring high quality of care, members getting their preventive care and reliable customer service for its members.
If you enroll in a plan you aren’t happy with during the AEP, eligible individuals have the opportunity to switch to a 5-star plan during the 5-star Special Enrollment Period, which runs from Dec. 8, 2022 - Nov. 30, 2023.
Finally, keep in mind that following health care appointments and throughout the year you could receive surveys from your physician, from Humana and from CMS. These surveys are all important, and, while similar, are used for different purposes and are your opportunity to provide feedback that will help improve the future of healthcare.
Humana is a Medicare Advantage HMO, PPO and PFFS organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. Every year, Medicare evaluates plans based on a 5-star rating system.