Community Focus

CMS Star Ratings: What You Need to Know

31 August 2021

If you are or will soon become eligible for Medicare benefits, you may have heard about the Star Ratings for Medicare plans. While you may not think too much of it, these ratings tell us a lot about the overall quality of a plan.

Providence has received consistently high scores across care and quality measurements, making our Medicare Advantage Plans one of the highest rated plans in our service areas within Oregon and Washington state. In fact, for the past 10 years, Providence Medicare Advantage Plans have maintained at least a 4.5 Star Rating. Providence has been able to do this by staying in tune with the needs of members and making changes accordingly.

If you are still wondering why Star Ratings matter and what sets Providence Medicare Advantage Plans apart from competitors, the information below explains the importance of these ratings and how they could impact your overall satisfaction with a plan.



Star Ratings & Why They Matter

Every year, Centers for Medicare and Medicaid Service (CMS) evaluates Medicare Advantage plans based a 5-Star Rating system and assigns new Star Ratings so consumers can compare choices. Each medical and prescription drug service is calculated to determine the Star Rating for each offering, and a combined score determines a plan’s overall Star Rating.

In recent years, new measurement standards from CMS have put a heavier emphasis on customer experience ratings (McKinsey & Company, 2020). The CMS announced in 2019 that Medicare Advantage contracts would need to maintain a minimum rating of three stars. This change highlighted the importance of a plan’s ability to provide members with continuous positive experiences, in addition to offering quality patient care that meets or exceeds industry standards.



Star Ratings Across the Country

According to 2020 Star Ratings data released by CMS, the majority (51%) Medicare Advantage plans that offer prescription drug coverage had an overall rating of less than four stars. Selecting a plan with an average or even below average rating could mean that you receive lower quality care, potentially impacting health outcomes. On the opposite side of the spectrum, plans that consistently receive high ratings demonstrate that they are frequently working to improve their quality of care and delivery. These plans will often implement tools that allow the insurer to conduct self-evaluations to identify areas of improvement that will have the most impact on patients.



How Providence Compares to the National Standard

In 2021, the average Star Rating for all Medicare Advantage plans with prescription drug coverage was 4.06. Not only did Providence exceeded the national average with our 4.5 rating but is in the top 15% of all health plans nationwide.

We pride ourselves on providing members with outstanding patient-centered care and services, which is reflected in our consistently high CMS rating. Our network of doctors and specialists share our commitment of providing members with high-quality services and excellent patient care. Additionally, the Providence Care Management team helps members take an active role in improving their health. Whether someone needs help with understanding a new diagnosis or assistance navigating options for care, Providence Care Management is here to help.



Where to Find Star Ratings

Star Ratings can be found and compared by using Medicare’s Plan Finder tool. New ratings are released every October and are applied to the following calendar year. The tool allows you to filter plans by your service area and allow you to look at the rating categories for Medicare Advantage Plans.



What if I have additional questions?

You can download our Simplifying Medicare Guide at ProvidenceHealthAssurance.com/guide for additional information. Our Medicare experts are available 8 a.m. to 8 p.m. (Pacific Time), Monday through Friday and can be reached at [503-574-5199 or 1-866-366-0540 (TTY: 711)].

There are also several free Medicare 101 webinars occurring in the upcoming months. To view the webinar dates and to learn more about what will be featured in the webinars, please visit:  ProvidenceHealthAssurance.com/medicare101.

Stay tuned for more Medicare-related tips and resources from Providence in the coming months. To learn more about Medicare plans and resources available from Providence, please visit: https://www.providencehealthplan.com/medicare.


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Disclaimer:

Every year, Medicare evaluates plans based on a 5-star rating system. Providence Medicare Advantage Plans is an HMO, HMO‐POS and HMO SNP with Medicare and Oregon Health Plan contracts. Enrollment in Providence Medicare Advantage Plans depends on contract renewal. H9047_2021PHA233_M.

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