Medicare Star Quality Rating System
Medicare plans are assigned an overall rating ranging from 1 to 5 stars based on the plan's performance. Ratings are updated annually and may change from year to year. The following information is from www.medicare.gov.
The Centers for Medicare and Medicaid Services' (CMS) Overall Plan Rating combines scores for the types of services each plan offers.
What is being measured?
For plans covering health services, the following are measured:
- Staying healthy: screenings, tests, and vaccines
- Managing chronic (long-term) conditions
- Ratings of health plan responsiveness and care
- Member complaints, problems getting services, and choosing to leave the plan
- Health plan customer service
For plans covering drug services, the following are measured:
- Drug plan customer service
- Member complaints, problems getting services, and choosing to leave the plan
- Member experience with plan’s drug services
- Drug pricing and patient safety
Where does the information for the rating come from?
For quality of health services, the information comes from sources that include:
- Member surveys done by Medicare
- Information from clinicians
- Information submitted by the plans
- Results from Medicare’s regular monitoring activities
For quality of drug services, the information comes from sources that include:
- Member surveys done by Medicare
- Reviews of billing and other information that plans submit to Medicare
- Results from Medicare’s regular monitoring activities
Why is the Overall Plan Rating important?
The Overall Plan Rating gives you a single summary score that makes it easy for you to compare plans based on quality and performance.