Detroit Medicare and ACA 2021

Checking star ratings helps consumers find high-quality health care plans

Dr. Charles Bloom
for Health Alliance Plan
Dr. Charles Bloom is senior vice president and chief medical officer at Health Alliance Plan.

Most people would never consider investing in an important purchase – a car, a house or even a kitchen appliance – without checking reviews and ratings. Yet when it comes to choosing a Medicare Advantage plan – an essential decision that helps us live to our fullest potentials – many people are not aware a rating system exists.

Medicare plans are rated by the Centers for Medicare & Medicaid Services, or CMS, a federal agency that oversees the national Medicare program. All health plans that offer Medicare coverage are evaluated by CMS each year as part of its Star Rating Program. The program rates health plans from one to five stars, with five being the highest. Plans are evaluated on quality, service and member satisfaction. These ratings can help Medicare members, their families and their caregivers compare the quality of Medicare plans.

To develop each health plan’s star rating, CMS measures more than 40 performance metrics in five categories. They are:

  • Staying healthy: screenings, tests and vaccines
  • Managing chronic (or long-term) conditions
  • Responsiveness and care
  •  Member complaints
  • Customer service

Star ratings measure a health plan’s ability to provide you with access to care, making sure the right doctors and hospitals are in your network and conveniently located to you. They also measure how much a health plan contributes to your positive health outcomes, such as helping you manage chronic conditions like diabetes, hypertension and congestive heart failure. In addition, they measure the customer experience. CMS surveys Medicare members about their satisfaction with their health plans, and the results of these member surveys are heavily weighted in the final star ratings.

Health plans that earn four stars or higher qualify for a quality bonus payment from CMS. This is important because these bonus payments are invested back into member benefits. When a Michigan-based insurer like HAP, for example, receives high-quality ratings, those federal bonus payments are invested back into programs and services that benefit Medicare beneficiaries in Michigan. These might include $0 premium plans, vision and dental benefits or over-the-counter allowances that cover the cost of nonprescription items.

It’s important to remember that while the Medicare Star Rating Program is a valuable tool, it shouldn’t be the only measure you use when choosing a health plan. You also need to make sure the plan offers the benefits and coverage you need at an affordable price and that your doctors and preferred hospitals are in the plan’s network (which can impact your out-of-pocket costs). Combined with a quality star rating, these factors can help you determine the best plan to meet your unique needs.

To compare Medicare Advantage plans, including their Star ratings, visit Medicare.gov.

About the expert

Dr. Charles Bloom is senior vice president and chief medical officer at Health Alliance Plan, or HAP, leading HAP’s clinical and operational programs in partnership with health care providers. He has more than 20 years of experience in health care and is board certified in emergency medicine.  

Members of the editorial and news staff of the USA TODAY Network were not involved in the creation of this content.
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