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
what the star ratings measure here.)
The chart below is a breakdown by health plan type for all 2013 Medicare Advantage plans.
Health Plan Type |
2013 Medicare Advantage Plan Star Ratings* |
Total
Plans*** |
n/a |
2 |
2.5 |
3** |
3.5 |
4 |
4.5 |
5 |
Cost Plans |
5 |
0 |
0 |
0 |
2 |
0 |
5 |
8 |
20 |
% |
25% |
0% |
0% |
0% |
10% |
0% |
25% |
40% |
|
Local HMO Plans |
85 |
0 |
53 |
106 |
115 |
57 |
62 |
12 |
490 |
% |
17% |
0% |
11% |
22% |
23% |
12% |
13% |
2% |
|
Local HMOs < 3 Stars |
Total: |
53 |
11% |
|
|
|
|
|
Local PPO Plans |
33 |
0 |
11 |
43 |
54 |
29 |
22 |
0 |
192 |
% |
17% |
0% |
6% |
22% |
28% |
15% |
11% |
0% |
|
Local PPOs < 3 Stars |
Total: |
11 |
6% |
|
|
|
|
|
Local MSA Plans |
3 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
|
100% |
0% |
0% |
0% |
0% |
0% |
0% |
0% |
|
Regional PPO Plans |
0 |
0 |
0 |
12 |
4 |
0 |
2 |
0 |
18 |
% |
0% |
0% |
0% |
67% |
22% |
0% |
11% |
0% |
|
Regional PPOs |
Total: |
0 |
0% |
|
|
|
|
|
< 3 Stars |
PFFS Plans |
7 |
0 |
6 |
9 |
8 |
0 |
0 |
0 |
30 |
% |
23% |
0% |
20% |
30% |
27% |
0% |
0% |
0% |
|
PFFS Plans < 3 Stars |
Total: |
6 |
20% |
|
|
|
|
|
Total MA Plans |
133 |
0 |
70 |
158 |
179 |
86 |
89 |
20 |
735 |
% |
18% |
0% |
10% |
21% |
24% |
12% |
12% |
3% |
|
All Plans < 3 Stars |
|
70 |
10% |
|
|
|
|
|
n/a means that these plans have not yet received a quality star rating. Either the plan is too new, or there is insufficient data to calculate a star rating.
*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 R1234). The total number of plans includes 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 of the Medicare
Cost plans that have a star rating, have a rating above the 3.0 Medicare benchmark with the vast majority of plans earning a 4.5-5 star rating.
Of the 490
local HMO plans, 53 or 11% of plans with ratings, have a rating that falls below the 3.0 star rating benchmark and only 12 plans (2%) have a 5-star (excellent) rating (this is up from only seven plans in 2012). These 12 plans would qualify for the 5-star special enrollment period that began with the 2012 plan year.
There are 159
local PPO plans evaluated for 2013, of which 11 fall below 3.0 stars (6%) and no local PPO plans have a 5-star rating. The majority of the local PPO plans fall within the 3-3.5 star range.
The star ratings for
regional PPO plans are lower than local PPO plans. This could be related to the realatively small number of regional plans verses local PPO plans. No plans fell below the 3.0 star rating benchmark and eighteen plans had a star rating at or above 3.0.
PFFS plans are hovering at the 3.0 star rating level. With six plans at 2.5 stars, nine plans earning 3 stars and eight plans earning 3.5 stars.
In summary, only 10% of all Medicare Advantage plans that were rated fell at or below a 3.0 star rating with the majority of plans clustering between 3 and 3.5 stars.