Is a Five-Star Medicare Plan Right for You?

Medicare has a star rating system for Medicare Advantage and Part D prescription drug plans. A top rating could benefit both plan members and sponsors.

The plans are rated from one to five stars (with half stars awarded) based on a number of measures of quality of care, member experience, and plan administration. Five stars is the top rating.

A benefit for any Medicare member is that when there is at least one five-star plan available in your area, you can switch to it at any time during the year. You aren’t restricted to the annual open enrollment period. You can move from traditional Medicare to a five-star Advantage plan, or move from an Advantage plan to a five-star Advantage plan any time. You also can switch to a five-star Part D plan from another Part D plan when you want.

Such a change can be made only one time during the year.

The plans also receive a benefit. Bonus payments per enrollee are made to each plan with four or more stars. The higher the plan’s rating, the higher the bonus. A portion of the bonuses must be used to provide additional benefits to enrollees or to reduce their out-of-pocket costs.

Like most such ratings, the star ratings should be only one factor in your decision. First, there are only a small number of five-star plans around the country. There might not be one available to you. Second, the ratings are generic. Medicare might weigh the factors differently than you do.

Third, a high rating doesn’t mean the plan is right for you. When a Part D plan has five stars but doesn’t cover a medication you need, there’s probably a better plan for you. You have to consider all the usual factors to see if a plan is a good fit for you.

You can review more than an overall rating on the Medicare web site. You can see how each plan performed in the different categories. Advantage plans are measured in five categories while Part D plans are measured in four categories.

RW November 2015.