Medicare can feel intimidating at times, with lots of choices and terms to figure out. One term you may hear is “5-Star Medicare Plan.” But what exactly does that mean, and why should you care?
At Midwestern Marketing, we understand how confusing it can be to try and learn all the technical terms in the insurance industry. After 25 years of business, we have had plenty of experience and knowledge with the Medicare star rating system. We are here to guide you as you learn the system and what it means for customers. Whether you are just starting with Medicare, or you have been using it for a while, knowing about 5-star plans can help you pick the best coverage.
What Is A Medicare Star Rating?
A 5-star Medicare plan is the highest standard of quality and service within the Medicare system. These plan’s performances are evaluated and rated by the Centers for Medicare and Medicaid Services (CMS), the federal agency responsible for administering Medicare. The plan’s star ratings are based on several key factors, including:
- Quality of Care: This encompasses various aspects such as preventative care, screenings and check-ups, vaccines, managing chronic conditions, members’ satisfaction, and overall health outcomes.
- Customer Service: The responsiveness and effectiveness of customer service provided by the plan, including accessibility to information and assistance.
- Member Experience: Feedback from plan members regarding their overall experience, including satisfaction with coverage, benefits, and ease of use.
- Health Plan Stability: The financial stability and reliability of the plan, making sure it can continue to provide quality care.
- Drug Coverage: For Medicare Advantage plans that offer prescription drug coverage (Part D), the quality of medications and drug pricing is also assessed.
A 5-star rating indicates exceptional performance in all these areas, showing beneficiaries that healthcare providers and insurance companies consistently deliver high-quality care and services.
How The Rating System Works
The CMS uses a rigorous evaluation process to assess Medicare coverage and assign ratings. CMS evaluates each plan using a comprehensive set of measures and benchmarks, which are then converted into a star rating on a scale of 1 to 5, with 5 being the highest rating. The star ratings are updated annually and are based on data collected throughout the year.
These quality ratings are intended to provide Medicare beneficiaries with a simple, transparent way to compare plan quality and performance. By considering factors beyond just cost, such as quality of care and customer satisfaction, beneficiaries can make more informed decisions about their healthcare coverage.
Enrolling In A 5-Star Plan
While 5-star Medicare plans are the top quality within the Medicare system, their availability can vary depending on location. Not all plans in all areas achieve this top rating. However, CMS does designate plans as “high performing” if they earn four stars or above, which still indicates a high level of quality.
The availability of 5-star Medicare plans can vary from year to year and by location. CMS evaluates and rates Medicare Advantage (Part C) plans, Medicare Prescription Drug (Part D) plans, and Medicare Advantage with Prescription Drug (MA-PD) plans annually. Therefore, the states where these plans are available can change based on the performance of plans in those regions.
To find out which states offer five-star Medicare plans each year, you can visit medicare.gov or use the Medicare Plan Finder tool provided by CMS. This tool allows you to search for plans available in your area and see their star ratings. Keep in mind that even if a plan has a five-star rating nationally, it may not be available in every state or county. Our licensed insurance agents have access to our proprietary software AgentXcelerator which is a quoting tools for clients, plus much more.
Next, talk to a licensed insurance agent to see if your chosen plan is a good fit. They will help you evaluate the overall star rating, deductibles and copays, health services offered, and more. They will also help you enroll in your new plan during a valid enrollment period, such as the Initial Enrollment Period or the Annual Enrollment Period (AEP).
While there is a Medicare 5-star special enrollment period that allows customers to enroll in or switch to a 5-star Medicare Advantage plan or Prescription Drug Plan outside of those times, it is best to enroll in a valid period to avoid a late enrollment penalty.
A 5-star Medicare plan represents more than just a rating – it shows a commitment to excellence and a dedication to improving the lives of Medicare beneficiaries. As you navigate the complexities of Medicare, remember the importance of choosing a plan that aligns with your individual preferences and requirements. Whether it is comprehensive coverage, innovative services, or exceptional customer care, the right plan is the one that empowers you to lead a healthier life with confidence and peace of mind.
Midwestern Marketing is a true FMO where a handshake still means something. We value our agents and take service and contracting to a new level. The teamwork and principles by which we operate are reflected in the thousands of agents we serve nationwide. Feel free to call 877-278-3775 or email us at info@midwesternmarketing.com. We are certain we can help you grow your business!