Each year, the Centers for Medicare and Medicaid Services (CMS) rate the quality of Medicare Part D and Medicare Advantage plans using various measures. In the end, an overall Star Rating is calculated for each Medicare plan. A summary rating of prescription drug plan quality and a separate summary rating of health plan quality are calculated where appropriate. Star Ratings are also awarded for various discrete aspects of Medicare Part D and Medicare Advantage plans. New Medicare Part D or Medicare Advantage plans naturally do not have any historical information, so they will not have any Star or quality ratings for the first year.
This section explains how the overall CMS Star Ratings are calculated and provides examples of plan quality.
The Overall Star Rating combines scores for the types of services each plan offers: What is being measured?
For plans covering only health services and not offering prescription drug coverage (MAs) the overall quality score is the same as the Summary Rating of Health Plan Quality. This star rating covers many different health services topics that fall into 5 categories.
Drug safety and accuracy of drug pricing: Includes how accurate the plan’s pricing information is and how often members with certain medical conditions are prescribed drugs in a way that is safer and clinically recommended for their condition.
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.
This information is gathered from several different sources. In some cases it is based on member surveys, information from clinicians, or information from plans. In other cases, it is based on results from Medicare’s regular monitoring activities.