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How Are Medicare Star Ratings Determined?

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By Daniel Petkevich
Sep 6, 2023

Medicare Star Ratings are used to evaluate and compare the quality and performance of Medicare Advantage and Prescription Drug Plans. These ratings help beneficiaries make informed decisions about their healthcare options. The star ratings range from 1 to 5 stars, with higher ratings indicating better quality and performance.

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The following are some of the factors that typically contribute to Medicare Star Ratings:
  1. Clinical Outcomes: This includes measures of how well the plan manages chronic conditions such as diabetes, heart disease, and high blood pressure. It also considers how often members receive recommended screenings and vaccinations.
  2. Member Experience: This involves member satisfaction surveys, feedback, and how well the plan handles member complaints and appeals.
  3. Preventive Care: Plans are rated on how well they encourage and provide preventive services such as vaccinations, screenings, and wellness visits.
  4. Customer Service: The quality of customer service, including call center support and timely responses to member inquiries and complaints.
  5. Drug Pricing and Patient Safety: For Prescription Drug Plans, factors include the accuracy of drug pricing, ensuring appropriate medication use, and reducing the risk of adverse drug events.
  6. Member Complaints and Appeals: How efficiently and effectively the plan addresses member complaints and appeals.
  7. Health Plan Responsiveness and Care: How well the plan responds to members' needs and coordinates care among healthcare providers.
It's important to note that the specific measures and weight assigned to each factor may vary from year to year. The

Centers for Medicare & Medicaid Services (CMS)

evaluates plans annually and updates the Star Ratings accordingly. Beneficiaries can use these ratings as a guide to choose a plan that meets their healthcare needs and preferences.
For the most up-to-date and detailed information on Medicare Star Ratings, visit

Medicare.gov

. You can also speak with one of our Mediare experts by scheduling a chat at

fairsquaremedicare.com

or by calling 1-888-454-2383. We're looking forward to talking to you!

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Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

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Virgil Insurance Agency, LLC (DBA Fair Square Medicare) and www.fairsquaremedicare.com are privately owned and operated by Help Button Inc. Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent/producer may contact you. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease. Virgil Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. Plan availability varies by region and state. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. © 2022 Help Button Inc

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