The Centers for Medicare & Medicaid Services (CMS) created the Star Ratings system to help Medicare beneficiaries, their families, and caregivers compare the quality of care provided by Medicare Advantage (MA) plans and Medicare Part D prescription drug plans. Each year, CMS assigns star ratings to MA and Part D plans based on their performance on a set of quality measures. The overall star rating for an MA or Part D plan is a summary measure that reflects the plan’s performance across all of the quality measures.
The Star Ratings system is important because it helps beneficiaries make informed decisions about their health insurance coverage. Beneficiaries can use the star ratings to compare the quality of MA and Part D plans in their area and choose the plan that best meets their needs. The star ratings can also help beneficiaries identify plans that are improving or declining in quality over time.
The Star Ratings system has been used to measure the quality of MA and Part D plans since 2008. Over time, CMS has made changes to the Star Ratings system to improve its accuracy and fairness. In 2025, CMS will implement a number of significant changes to the Star Ratings system. These changes are designed to better reflect the quality of care provided by MA and Part D plans and to make it easier for beneficiaries to compare plans.
1. Quality of care
Quality of care is one of the most important factors that CMS considers when assigning Star Ratings to Medicare Advantage and Part D plans. Quality of care measures assess how well a plan provides preventive care, manages chronic conditions, and coordinates care for its members. CMS uses a variety of data sources to measure quality of care, including claims data, medical records, and surveys of members and providers.
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Preventive care
Preventive care measures assess how well a plan provides recommended preventive services, such as cancer screenings, immunizations, and well-child visits. Preventive care is important because it can help to prevent serious health problems from developing in the future.
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Chronic care management
Chronic care management measures assess how well a plan provides care for members with chronic conditions, such as diabetes, heart disease, and cancer. Chronic care management is important because it can help to improve the health of members with chronic conditions and prevent complications.
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Coordination of care
Coordination of care measures assess how well a plan coordinates care for its members, such as by providing care management services and ensuring that members have access to the specialists and services they need. Coordination of care is important because it can help to improve the quality of care and reduce costs.
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Health outcomes
Health outcomes measures assess how well a plan’s members are doing in terms of their health status. Health outcomes measures include things like mortality rates, hospital readmission rates, and patient satisfaction. Health outcomes are important because they reflect the overall quality of care that a plan provides.
The quality of care measures that CMS uses to calculate Star Ratings are based on the latest clinical evidence and research. CMS regularly reviews and updates the measures to ensure that they are measuring the most important aspects of quality of care. The Star Ratings system is a valuable tool that can help beneficiaries compare the quality of Medicare Advantage and Part D plans and make informed decisions about their health insurance coverage.
2. Customer service
Customer service is an important component of the 2025 Medicare Star Ratings. The Star Ratings are a set of quality measures that the Centers for Medicare & Medicaid Services (CMS) uses to rate Medicare Advantage and Part D plans. Customer service measures assess how well a plan responds to member inquiries, resolves complaints, and provides timely and accurate information. CMS uses a variety of data sources to measure customer service, including surveys of members and providers.
Customer service is important because it can affect a member’s overall experience with a health plan. Good customer service can help to build trust and rapport between members and their plan, and it can make it easier for members to get the care and services they need. Poor customer service, on the other hand, can lead to frustration and dissatisfaction, and it can make it difficult for members to get the care they need.
The 2025 Star Ratings include a number of customer service measures, such as:
- Percentage of calls answered within a certain number of rings
- Percentage of calls resolved within a certain amount of time
- Percentage of members who are satisfied with the plan’s customer service
Plans that receive high customer service ratings are more likely to attract and retain members. This is because members want to know that they can count on their plan to provide them with the help and support they need. Good customer service can also help to improve member satisfaction and loyalty.
The 2025 Star Ratings are an important tool that can help beneficiaries compare the quality of Medicare Advantage and Part D plans. Beneficiaries should consider the customer service ratings when choosing a plan. Plans with high customer service ratings are more likely to provide members with the help and support they need.
3. Cost
Cost is an important component of the 2025 Medicare Star Ratings. The Star Ratings are a set of quality measures that the Centers for Medicare & Medicaid Services (CMS) uses to rate Medicare Advantage and Part D plans. Cost measures assess how well a plan manages its costs and provides affordable care to its members. CMS uses a variety of data sources to measure cost, including claims data and financial reports.
Cost is important because it can affect a member’s ability to access and afford the care they need. High costs can make it difficult for members to pay for their premiums, deductibles, and copays. This can lead to members delaying or avoiding care, which can have a negative impact on their health. Affordable care, on the other hand, can make it easier for members to get the care they need, which can lead to better health outcomes.
The 2025 Star Ratings include a number of cost measures, such as:
- Average monthly premium
- Average annual deductible
- Average annual out-of-pocket costs
Plans that receive high cost ratings are more likely to attract and retain members. This is because members want to know that they can afford the care they need. Affordable care can also help to improve member satisfaction and loyalty.
The 2025 Star Ratings are an important tool that can help beneficiaries compare the quality of Medicare Advantage and Part D plans. Beneficiaries should consider the cost ratings when choosing a plan. Plans with high cost ratings are more likely to provide members with affordable care.
4. Access to care
Access to care is a key component of the 2025 Medicare Star Ratings. The Star Ratings are a set of quality measures that the Centers for Medicare & Medicaid Services (CMS) uses to rate Medicare Advantage and Part D plans. Access to care measures assess how well a plan provides members with timely and affordable access to the care they need.
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Provider network
The size and scope of a plan’s provider network is an important factor in access to care. A plan with a large network of providers is more likely to have providers located in convenient locations and with available appointments. This can make it easier for members to get the care they need, when they need it.
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Transportation
Some plans offer transportation services to members who need help getting to and from appointments. This can be a valuable service for members who do not have access to reliable transportation. It can also help to improve access to care for members who live in rural or underserved areas.
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Language services
Plans are required to provide language services to members who are not proficient in English. This includes providing translated materials and interpreters for appointments. Language services can help to ensure that members understand their care options and can make informed decisions about their health.
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Cultural competency
Cultural competency is the ability of a health care provider to understand and respect the cultural beliefs and values of their patients. Culturally competent care can help to improve access to care for members from diverse backgrounds. It can also help to improve health outcomes.
Plans that receive high access to care ratings are more likely to attract and retain members. This is because members want to know that they can get the care they need, when they need it. Good access to care can also help to improve member satisfaction and loyalty.
The 2025 Star Ratings are an important tool that can help beneficiaries compare the quality of Medicare Advantage and Part D plans. Beneficiaries should consider the access to care ratings when choosing a plan. Plans with high access to care ratings are more likely to provide members with the care they need, when they need it.
5. Preventive care
Preventive care is an essential part of maintaining good health and well-being. It includes regular checkups, screenings, and immunizations that can help prevent or catch health problems early, when they are easier to treat. Preventive care is especially important for older adults, who are more likely to develop chronic health conditions.
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Regular checkups
Regular checkups with a doctor or other health care provider can help to identify and address health problems early, when they are easier to treat. Checkups can also help to establish a relationship with a health care provider, which can make it easier to get the care you need when you are sick or injured.
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Screenings
Screenings are tests that can help to find health problems early, before you have any symptoms. Screenings can be used to detect a variety of health conditions, including cancer, heart disease, and diabetes. Early detection can lead to earlier treatment and better outcomes.
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Immunizations
Immunizations can protect you from a variety of infectious diseases, including the flu, pneumonia, and shingles. Immunizations are an important part of preventive care for older adults, who are more likely to develop serious complications from these diseases.
The 2025 Medicare Star Ratings include a number of measures related to preventive care. These measures assess how well a plan provides preventive services to its members, such as cancer screenings, immunizations, and well-child visits. Plans that receive high preventive care ratings are more likely to provide members with the care they need to stay healthy and avoid serious health problems.
6. Chronic care management
Chronic care management (CCM) is a set of services that helps people with chronic conditions manage their health and improve their quality of life. CCM services can include:
- Care planning
- Medication management
- Education and self-management support
- Coordination of care
CCM can help people with chronic conditions live healthier lives by improving their ability to manage their condition, reducing their risk of complications, and avoiding unnecessary hospitalizations.
The 2025 Medicare Star Ratings include a number of measures related to CCM. These measures assess how well a plan provides CCM services to its members, such as the percentage of members with a chronic condition who have a care plan, the percentage of members who receive medication management services, and the percentage of members who receive education and self-management support. Plans that receive high CCM ratings are more likely to provide members with the care they need to manage their chronic conditions and improve their quality of life.
CCM is an important part of the 2025 Medicare Star Ratings because it is a key component of providing high-quality care to people with chronic conditions. By providing CCM services, plans can help their members to live healthier lives and avoid unnecessary hospitalizations. This can lead to better health outcomes for members and lower costs for plans.
7. Medication adherence
Medication adherence is a key component of the 2025 Medicare Star Ratings. The Star Ratings are a set of quality measures that the Centers for Medicare & Medicaid Services (CMS) uses to rate Medicare Advantage and Part D plans. Medication adherence measures assess how well a plan helps its members take their medications as prescribed. CMS uses a variety of data sources to measure medication adherence, including claims data and surveys of members and providers.
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Importance of medication adherence
Medication adherence is important because it can improve health outcomes and reduce costs. When members take their medications as prescribed, they are more likely to manage their chronic conditions and avoid complications. This can lead to fewer hospitalizations and emergency room visits, which can save money for both members and plans.
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Factors that affect medication adherence
There are a number of factors that can affect medication adherence, including the type of medication, the dosing schedule, and the member’s health literacy. Plans can play an important role in improving medication adherence by providing members with education and support. This can include providing information about the member’s medications, helping them to develop a medication schedule, and providing reminders to take their medications.
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How plans can improve medication adherence
There are a number of things that plans can do to improve medication adherence. These include:
- Providing members with education and support
- Using technology to improve medication adherence
- Partnering with community organizations
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The role of the Star Ratings in improving medication adherence
The Star Ratings can play an important role in improving medication adherence. By rewarding plans that have high medication adherence rates, CMS can encourage plans to invest in programs and services that improve medication adherence. This can lead to better health outcomes for members and lower costs for plans.
Medication adherence is a complex issue, but it is one that is essential to address. By working together, plans and CMS can improve medication adherence and improve the health of Medicare beneficiaries.
8. Health outcomes
Health outcomes are an important part of the 2025 Medicare Star Ratings. The Star Ratings are a set of quality measures that the Centers for Medicare & Medicaid Services (CMS) uses to rate Medicare Advantage and Part D plans. Health outcomes measures assess how well a plan’s members are doing in terms of their health status. CMS uses a variety of data sources to measure health outcomes, including claims data, medical records, and surveys of members and providers.
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Mortality rates
Mortality rates measure the number of deaths per 100,000 people in a plan’s membership. Lower mortality rates indicate that a plan’s members are living longer, healthier lives.
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Hospital readmission rates
Hospital readmission rates measure the number of times a plan’s members are readmitted to the hospital within a certain period of time after being discharged. Lower hospital readmission rates indicate that a plan’s members are getting the care they need to stay healthy and out of the hospital.
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Patient satisfaction
Patient satisfaction measures assess how satisfied a plan’s members are with the quality of care they receive. Higher patient satisfaction scores indicate that a plan’s members are happy with the care they are receiving.
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Health-related quality of life
Health-related quality of life measures assess how well a plan’s members are able to function in their daily lives. Higher health-related quality of life scores indicate that a plan’s members are able to live active, fulfilling lives.
Health outcomes are important because they reflect the overall quality of care that a plan provides. Plans that receive high health outcomes ratings are more likely to provide their members with the care they need to live healthy, fulfilling lives.
FAQs on 2025 Medicare Star Ratings
The 2025 Medicare Star Ratings are a set of quality measures that the Centers for Medicare & Medicaid Services (CMS) will use to rate Medicare Advantage and Part D plans starting in 2025. The ratings will be based on a variety of factors, including the plan’s quality of care, customer service, and cost. The Star Ratings are designed to help beneficiaries compare the quality of plans and make informed decisions about their health insurance coverage.
Question 1: What are the 2025 Medicare Star Ratings?
Answer: The 2025 Medicare Star Ratings are a set of quality measures that CMS will use to rate Medicare Advantage and Part D plans starting in 2025. The ratings will be based on a variety of factors, including the plan’s quality of care, customer service, and cost.
Question 2: Why are the Star Ratings important?
Answer: The Star Ratings are important because they help beneficiaries compare the quality of Medicare Advantage and Part D plans. The ratings can help beneficiaries make informed decisions about their health insurance coverage and choose the plan that best meets their needs.
Question 3: What factors are used to calculate the Star Ratings?
Answer: The Star Ratings are based on a variety of factors, including the plan’s quality of care, customer service, and cost. Quality of care measures assess how well a plan provides preventive care, manages chronic conditions, and coordinates care for its members. Customer service measures assess how well a plan responds to member inquiries, resolves complaints, and provides timely and accurate information. Cost measures assess how well a plan manages its costs and provides affordable care to its members.
Question 4: How can I use the Star Ratings to compare plans?
Answer: You can use the Star Ratings to compare plans by visiting the Medicare Plan Finder website. The Plan Finder allows you to search for plans in your area and compare their Star Ratings. You can also compare plans by calling 1-800-MEDICARE (1-800-633-4227).
Question 5: When will the 2025 Star Ratings be released?
Answer: The 2025 Star Ratings will be released in October 2024.
Question 6: Where can I find more information about the Star Ratings?
Answer: You can find more information about the Star Ratings on the Medicare Plan Finder website or by calling 1-800-MEDICARE (1-800-633-4227).
Summary: The 2025 Medicare Star Ratings are an important tool that can help beneficiaries compare the quality of Medicare Advantage and Part D plans. The ratings are based on a variety of factors, including the plan’s quality of care, customer service, and cost. Beneficiaries can use the Star Ratings to make informed decisions about their health insurance coverage and choose the plan that best meets their needs.
Transition to the next article section: For more information about the 2025 Medicare Star Ratings, please visit the Medicare Plan Finder website or call 1-800-MEDICARE (1-800-633-4227).
Tips for Using the 2025 Medicare Star Ratings
The 2025 Medicare Star Ratings are a valuable tool that can help you compare the quality of Medicare Advantage and Part D plans. By following these tips, you can make the most of the Star Ratings and choose the plan that best meets your needs.
Tip 1: Understand the different Star Ratings categories.
The Star Ratings are based on five categories: quality of care, customer service, cost, access to care, and preventive care. Each category is rated on a scale of 1 to 5 stars, with 5 stars being the highest rating. It is important to understand what each category measures so that you can focus on the categories that are most important to you.
Tip 2: Compare plans within the same category.
When comparing plans, it is important to compare them within the same category. For example, if you are looking for a plan with high quality of care, you should compare plans that have 4 or 5 stars for quality of care. This will help you to narrow down your choices and find the plan that is right for you.
Tip 3: Consider your individual needs.
When choosing a plan, it is important to consider your individual needs. For example, if you have a chronic condition, you may want to choose a plan that has a high rating for chronic care management. If you are on a tight budget, you may want to choose a plan that has a low cost rating. By considering your individual needs, you can choose the plan that is right for you.
Tip 4: Use the Medicare Plan Finder website.
The Medicare Plan Finder website is a great resource for comparing Medicare Advantage and Part D plans. The website allows you to search for plans in your area and compare their Star Ratings. You can also compare plans by calling 1-800-MEDICARE (1-800-633-4227).
Tip 5: Talk to your doctor or pharmacist.
Your doctor or pharmacist can be a valuable resource when choosing a Medicare Advantage or Part D plan. They can help you understand your health needs and recommend a plan that is right for you.
Summary: By following these tips, you can make the most of the 2025 Medicare Star Ratings and choose the plan that best meets your needs.
Transition to the article’s conclusion: For more information about the 2025 Medicare Star Ratings, please visit the Medicare Plan Finder website or call 1-800-MEDICARE (1-800-633-4227).
Conclusion
The 2025 Medicare Star Ratings are a valuable tool that can help you compare the quality of Medicare Advantage and Part D plans. By understanding the different Star Ratings categories, comparing plans within the same category, considering your individual needs, and using the Medicare Plan Finder website, you can choose the plan that best meets your needs.
The Star Ratings are an important part of the Medicare program. They help beneficiaries make informed decisions about their health insurance coverage and choose the plan that is right for them. By using the Star Ratings, you can be confident that you are choosing a plan that provides high-quality care at an affordable price.
