Medicare uses information from member satisfaction surveys, plans, and health care providers to give overall performance star ratings to Medicare Advantage plans. These ratings are an incentive for Medicare plans to improve plan quality by making it easier for beneficiaries to compare and choose plans based on quality and performance. (You can read more about how the
quality ratings for the 2011 Medicare Prescription Drug plans and Medicare Advantage plans compare with the 2012 plans or about
what the star ratings measure here.)
The chart below is a breakdown by health plan type for all 2012 Medicare Advantage plans.
Health Plan Type |
2012 Medicare Advantage Plan Star Ratings* |
Total
Plans*** |
2 |
2.5 |
3** |
3.5 |
4 |
4.5 |
5 |
Cost Plans |
0 |
0 |
0 |
1 |
3 |
4 |
0 |
8 |
% |
0% |
0% |
0% |
22% |
67% |
89% |
0% |
|
Local HMO Plans |
15 |
81 |
87 |
69 |
43 |
26 |
7 |
328 |
% |
5% |
25% |
27% |
21% |
13% |
8% |
2% |
|
Local HMOs < 3 Stars |
96 |
29% |
|
|
|
|
|
Local PPO Plans |
5 |
23 |
32 |
33 |
22 |
11 |
1 |
127 |
% |
4% |
18% |
25% |
26% |
17% |
9% |
1% |
|
Local PPOs < 3 Stars |
28 |
22% |
|
|
|
|
|
Regional PPO Plans |
0 |
4 |
7 |
0 |
1 |
0 |
0 |
12 |
% |
0% |
33% |
58% |
0% |
8% |
0% |
0% |
|
Regional PPOs
< 3 Stars |
4 |
33% |
|
|
|
|
|
PFFS Plans |
1 |
4 |
6 |
0 |
0 |
2 |
0 |
13 |
% |
8% |
31% |
46% |
0% |
0% |
15% |
0% |
|
PFFS Plans < 3 Stars |
5 |
38% |
|
|
|
|
|
Total MA Plans |
21 |
112 |
132 |
103 |
69 |
43 |
8 |
488 |
% |
4% |
23% |
27% |
21% |
14% |
9% |
2% |
|
All Plans < 3 Stars |
133 |
27% |
|
|
|
|
|
*Medicare Advantage plans both with and without prescription drug coverage are included in the numbers above (but if the same contract has both with and without prescription drug coverage, the plan is only counted once).
**A star rating of 3
means average performance. Star rating definitions.
****Medicare uses the term plan(s) to mean the contract identifier associated with the plan. In the chart above the total plans is the total number of unique contract id (ex: H1234 or S1234). The total number of plans does not include plans that either did not have enough data to calculate a summary score or were too new to be measured.
From the table above, we can see that all Medicare
Cost plans have a star rating above the 3.0 Medicare benchmark with the vast majority of plans earning a 4-4.5 star rating.
Of the 328
local HMO plans, 96 or 29% of plans fall below the 3.0 star rating benchmark and seven plans (2%) have a 5-star (excellent) rating. These seven plans would qualify 5-star special enrollment period that began with the 2012 plan year.
There are 127
local PPO plans evaluated in 2012, of which 28 fall below 3.0 stars (22%) and only one plans has a 5-star rating. The majority of plans fall within the 3-3.5 star range.
The star ratings for
regional PPO plans was surprisingly lower than local PPO plans. This could be realted to the realatively small number of regional plans verses local PPO plans. Four plans fell below the 3.0 star rating benchmark (33%) and only one plan had a star rating above 3.0.
PFFS plans were consistently at the lower end of the scale. With 38% of plans below 3 stars, 46% earning 3 stars and only two plans earning above 3 stars.