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Understanding the 2020 CMS Star Ratings - Drug Plan Customer Service
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.
This category shows how each plan performs in customer service areas. For example, it shows how quickly and how well the plan handles appeals made by members.

This category is based on three (3) measures:



The drug plan customer service data comes from several sources. The information about appeals comes from an independent reviewer (also known as the Independent Review Entity or (IRE). This organization evaluates the drug plan’s appeals decisions. This information is based on cases processed by the independent reviewer in 2018 and 2019.

Additional data source information for each sub-category is outlined below.




Call Center — Foreign Language Interpreter and TTY Availability

Availability of TTY services and foreign language interpretation when prospective members call the drug plan. Percent of the time that the TTY services and foreign language interpretation were available when needed by prospective members who called the drug plan’s prospective enrollee customer service phone number.

Data Source:
The information about the availability of TTY services and foreign language interpretation comes from systematic studies that Medicare does to check on how well the plan is handling calls from prospective members. It is based on calls made to the plan’s prospective enrollee customer service phone number during the period from 02/2019 – 06/2019.

This measure has a weight of 1.5 when combined with other measures to calculate the summary ratings.




Drug Plan Fails to Make Timely Decisions about Appeals

Percent of plan members who failed to get a timely response when they made an appeal request to the drug plan about a decision to refuse payment or coverage. If you would like more information about Medicare appeals, go to www.medicare.gov/claims-and-appeals/index.html

Appeals Auto—Forward Data Source:
The information about whether the drug plan is making timely appeal decisions comes from an independent reviewer (also known as the Independent Review Entity or IRE). If the drug plan does not meet Medicare’s deadlines for providing the appeal decision, the appeal case is sent to the independent reviewer. This measure shows the rate (per 10,000 members) of cases sent to the independent reviewer because the plan did not make a timely decision. This information is based on cases processed by the independent reviewer during calendar year 2018.

This measure has a weight of 1.5 when combined with other measures to calculate the summary ratings.




Fairness of Drug Plan’s Appeal Decisions

Fairness of Drug Plan’s Appeal Decisions, Based on an Independent Reviewer This measure/rating shows how often an Independent Reviewer thought the drug plan’s decision to deny an appeal was fair. This includes appeals made by plan members and out-of-network providers. (This rating is not based on how often the plan denies appeals, but rather how fair the plan is when they do deny an appeal.)

Appeals Upheld Data Source:
The information about whether the drug plan is making fair appeal decisions comes from an independent reviewer (also known as the Independent Review Entity or IRE). This organization evaluates Part D appeals after the drug plan’s review. This measure shows the percent of cases in which the independent reviewer agreed with the drug plans’ decision. This information is based on cases processed by the independent reviewer during calendar year 2018.

This measure has a weight of 1.5 when combined with other measures to calculate the summary ratings.


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  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
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  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
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  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.
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