The member complaints and changes in the health plan’s performance data comes from multiple sources: The information about complaints is from Medicare’s Complaints Tracking Module and includes complaints Medicare received about the plan. The information about members choosing to leave the plan is from Medicare’s enrollment system. It is based on the percent of members who decided to leave the plan. The information about improvement in the plan’s performance is based on the other ratings on this Web site. To calculate the plan’s improvement rating, Medicare compares the plan’s previous scores to its current scores for all of the topics shown on this Web site. Then Medicare averages the results to give the plan its improvement rating.

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

Complaints about the Health Plan

Complaints about the health plan (more stars are better because it means fewer complaints). How many complaints Medicare received about the health plan.

Data Source:
The information about complaints is from Medicare’s Complaints Tracking Module (CTM). These rates represent the number of complaints received for every 1,000 people enrolled in the drug plan (based on Medicare enrollment records), adjusted to a 30-day basis. These data include complaints received.

Members Choosing to Leave the Plan

Members choosing to leave the plan (more stars are better because it means fewer members are choosing to leave the plan). The percent of plan members who chose to leave the plan. (This does not include members who did not choose to leave the plan, such as members who moved out of the service area.)

Data Source:
The information about members choosing to leave the plan is from Medicare’s enrollment system. It is based on the percent of members who decided to leave the plan.

Beneficiary Access and Performance Problems

Problems Medicare found in the plan’s performance (more stars are better because it means fewer serious problems). Each year, Medicare checks each plan to see if there are problems with the plan. For example, Medicare checks whether:

• Members are having problems getting services, and
• Plans are following all of Medicare’s rules.

Medicare gives the plan a score from 0 to 100. Plans get a lower score when Medicare finds problems. A higher score is better because it means Medicare found fewer problems.

Data Source:
The information about problems getting services is from Medicare’s reviews.

Health Plan Quality Improvement (if any)

Improvement (if any) in the health plan’s performance. This shows how much the health plan’s performance has improved or declined from one year to the next year. To calculate the plan’s improvement rating, Medicare compares the plan’s previous scores to its current scores for all of the topics shown on this website. Then Medicare averages the results to give the plan its improvement rating.

• If a plan receives 1 or 2 stars, it means, on average, the plan’s scores have declined (gotten worse).
• If a plan receives 3 stars, it means, on average, the plan’s scores have stayed about the same.
• If a plan receives 4 or 5 stars, it means, on average, the plan’s scores have improved.

Keep in mind that a plan that is already doing well in most areas may not show much improvement. It is also possible that a plan can start with low ratings, show a lot of improvement, and still not be performing very well.

Data Source:
The information about improvement in the plan’s performance is based on the other ratings on this Web site. To calculate the plan’s improvement rating, Medicare compares the plan’s previous scores to its current scores for all of the topics shown on this Web site. Then Medicare averages the results to give the plan its improvement rating.