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Understanding the 2022 CMS Star Ratings - Health Plan Customer Service HD5
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.
Does the plan do a good job handling members’ appeals and processing new enrollment requests? 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) sub-categories:



The health plan customer service data comes from multiple sources: The information about appeals comes from an independent reviewer (also known as the Independent Review Entity or [IRE]). This organization evaluates the health plan’s appeals decisions. This information is based on cases processed by the independent reviewer in 2020 and 2021.

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




Health Plan Makes Timely Decisions about Appeals

Percent of plan members who got a timely response when they made an appeal request to the health plan about a decision to refuse payment or coverage.

Data Source:
The information about appeals comes from an independent reviewer (also known as the Independent Review Entity or (IRE). This organization evaluates the health plan’s appeals decisions. This information is based on cases processed by the independent reviewer in 2020.

This measure has a weight of 2.0 when combined with other measures to calculate the summary ratings.




Fairness of Drug Plan’s Appeal Decisions

Fairness of the health plan’s appeal decisions, based on an Independent Reviewer. This measure/rating shows how often an Independent Reviewer thought the health 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.)

Data Source:
The information about appeals comes from an independent reviewer (also known as the Independent Review Entity or (IRE). This organization evaluates the health plan’s appeals decisions. This information is based on cases processed by the independent reviewer in 2020.

This measure has a weight of 2.0 when combined with other measures to calculate the summary ratings.




Call Center — Foreign Language Interpreter and TTY Availability

Availability of TTY services and foreign language interpretation when prospective members call the health 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 02/2021 – 06/2021.

This measure has a weight of 2.0 when combined with other measures to calculate the summary ratings.


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Tips & Disclaimers
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  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
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  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
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  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDPCompare.com and MACompare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing 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.
    Statement required by Medicare:
    "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
  • 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.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • 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.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • 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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