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.
Member complaints and changes in the drug plan’s performance: Includes how often Medicare found problems with the plan and how often members had problems with the plan. Includes how much the plan’s performance has improved (if at all) over time.
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 summary rating gives an overall score of the plan’s quality and performance on many different topics that fall into 5 categories:
Staying healthy: screenings, tests, and vaccines. Includes whether members got various screening tests, vaccines, and other check-ups that help them stay healthy.
Managing chronic (long-term) conditions: Includes how often members with different conditions got certain tests and treatments that help them manage their condition.
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.