Comparing 2011 and 2012 Medicare Plan Star Ratings

Medicare Advantage plans and Prescription Drug plans can earn a star rating from one to five stars. A 2-star rating means below average performance and a 5-star rating is considered excellent. Currently, no Medicare plans have a star rating of less than a 2-stars. Medicare uses information from member satisfaction surveys, plans, and health care providers to give overall performance star ratings to Medicare 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.

For plans covering health services, the overall score for quality of those services covers 36 different topics in five categories. For plans covering prescription drug services, the overall score for quality of those services covers 17 different topics in four categories. For plans covering both health and prescription drug services, the overall quality score quality for those services covers all 53 topics in nine categories.

An overall plan rating is then calculated and gives the beneficiary a single summary score that makes it easier to compare plans based on quality and performance. The overall CMS plan rating is included in the optional plan features on our PDP-Finder and MA-Finder tools. Example: California Medicare Prescription Drug Plans. Example: Broward County, Florida Medicare Advantage Plans.

A review of historical data for 2011 and 2012 shows a surprising drop in Medicare plan quality ratings rather than the expected increase.

2011 Medicare Plans:
The first chart is for 2011 Medicare Prescription Drug Plans (PDP) and Medicare Advantage Plans (MAs) which use the 2010 Medicare summary rating. The average 2011 plan star rating for PDP plans was 3.53 and the average star rating for MA plans was 3.32.

2011 Plans - Medicare Star Rating
2	2.5	3	3.5	4	4.5	5	Total Plans*
PDPs with rating	0	5	17	22	6	6	4	60
% PDPs with rating	0%	8%	28%	37%	10%	10%	7%	average rating 3.53
PDPs with rating lower than 3.0	5		8%
Medicare Advantage Plans (MAs)**	2	56	170	136	49	31	5	449
% MAs with rating**	0%	12%	38%	30%	11%	7%	1%	average rating** 3.32
MAs with rating lower than 3.0	58		13%

2012 Plans - Medicare Star Rating
2	2.5	3	3.5	4	4.5	5	Total Plans*
PDPs with rating	3	19	14	14	8	1	2	65
% PDPs with rating	5%	29%	22%	22%	12%	2%	3%	average rating 2.94
PDPs with rating lower than 3.0	22		34%
Medicare Advantage Plans (MAs)**	21	112	132	103	69	43	8	488
% MAs with rating**	4%	23%	27%	21%	14%	9%	2%	average rating** 3.25
MAs with rating lower than 3.0	133		27%

*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).
**Medicare Advantage plans include all types (Cost, PFFS, HMO, PPO, regional and local). If the same contract was offered with and without prescription drug coverage, it was only counted once.

Only 8% of all 2011 stand-alone prescription drug plans had a star rating less than 3.00, whereas, 34% of all 2012 stand-alone prescription drug plans had an summary star rating less than 3.00. 2012 Medicare Advantage plans also saw increase in the number of plans falling under the 3.00 star rating benchmark 2011 had 13% of all Medicare Advantage plans under the 3.00 star rating and 2012 saw 27% of all MA plans under 3.00.

The star ratings are becoming increasingly important as Medicare entices plans to increase plan quailty by added the special enrollment period for 5-star plans introduced for the 2012 plan year and the proposed 2013 special enrollment period for consistently low performing plans.

The following chart show the change tendancy for the plan star ratings from 2011 to 2012. For example, there were a total of 17 2011 plans with a 3-star rating. Of those plans, seven plans' star rating was lowered in 2012 (41%). Nine plans' star rating remained unchanged from 2011 to 2012 (53%). Only one plan had an increase in its star rating.

Change in 2011 Stand-Alone Prescription Drug Plan Ratings for 2012
Plans with a Star Rating Decrease		Plans whose Star Rating Stayed the same		Plans with a Star Rating Increase
Stars	Plans	%	Plans	%	Plans	%
2011 Plan Rating	2	0	0%	0	0%	0	0%
	2.5	1	20%	4	80%	0	0%
	3	7	41%	9	53%	1	6%
	3.5	10	50%	5	25%	5	25%
	4	5	83%	0	0%	1	17%
	4.5	6	100%	0	0%	0	0%
	5	2	50%	2	50%	0	0%

2011 Medicare Advantage plans showed a similar tendancy in star rating changes from 2011 to 2012. See chart below.

Change in 2011 Medicre Advantage Plan Ratings for 2012
Plans with a Star Rating Decrease		Plans whose Star Rating Stayed the same		Plans with a Star Rating Increase
Stars	Plans	%	Plans	%	Plans	%
2011 Plan Rating	2	0	0%	0	0%	2	100%
	2.5	8	16%	22	43%	21	41%
	3	60	36%	59	36%	47	28%
	3.5	56	42%	44	33%	34	25%
	4	24	50%	10	21%	14	29%
	4.5	18	58%	11	35%	2	6%
	5	2	40%	3	60%	0	0%