For plans covering health services and no prescription drug coverage (MAs), the overall score for quality is the same as the summary rating of health plan quality.
For plans covering only prescription drugs and no health services (PDPs), the overall score for quality is the same as the summary rating of drug plan quality.
For plans covering both health services and prescription drug coverage (MAPds), the overall score for quality calculated from the underlying topics from both the health plan summary and the drug plan summary.
Overall Star Rating
The Overall Star Rating is used to determine if a Medicare plan qualifies for the 5-Star Special Enrollment Period or if the Medicare plan falls into the consistently low performing Special Enrollment Period.
The Overall Star Rating combines scores for the types of services each plan offers: What is being measured?
Summary Rating of Health Plan Quality
What is being measured? For plans covering health services, the overall score for quality of those services covers many different topics that fall into 5 categories:
Summary Rating of Prescription Drug Plan Quality
This summary rating gives an overall score on the drug plan’s quality and performance in many different topics that fall into 4 categories:
This information is gathered from several different sources. In some cases it is based on member surveys. In other cases, it is based on reviews of billing and other information that plans submit to Medicare results from Medicare’s regular monitoring activities.