How To Find A 5 Star Rated Medicare Advantage Plan 2014

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In 2014, about half of all Medicare advantage plan subscribers will be enrolled in 4 and 5 stars plans, as CMS.gov (The Centers for Medicare & Medicaid Services) has announced in fall 2013. 9% of all beneficiaries will be members of five star plans, while 43% subscribe to plans with four stars, and another 43% to plans rated with 3 stars.

What Are 5 Star Medicare Advantage Plans?

In an effort to provide more transparency and improve the overall quality of Medicare advantage plans, CMS introduced a scale from 1 to 5 stars to rate advantage plans each year after their previous year’s performance was audited. High performance results in a 5 star rating, while one star represents poor performance of a plan.

Since the star rating was introduced a few years ago, plan providers have “really dedicated themselves to quality improvement”, a CMS official explained.

The star rating has also greatly influenced Medicare beneficiaries, as more are making each year active switches into higher rated plans.

How To Find A 5 Star Medicare Advantage Plan?

You can download a current list of Gold Star/High Performing Medicare Advantage Plans for 2014 with and without drug coverage at CMS.gov.

While not all plans are available in all local areas, you may get a feeling for good and not so good performing insurance providers. To find a 4 or 5 Star high rated Medicare advantage plan that best meets your health care needs and budget, a good starting point is using the Medicare Plan Finder at MyMedicare.gov.

After entering your zip code and some other important criteria, such as your current prescription drug needs, you will see a list with available advantage plans. Each plan’s rating can be found next to the plan’s description. 5-star plans are marked with a golden star icon, while a red alert icon indicates a poor performing plan.

The annual ratings are published by CMS each year in fall before the start of the Medicare open enrollment period on October 15th where beneficiaries are allowed to enroll in and switch plans.

To determine the ratings, CMS audits advantage plans according to over 35 different quality signals, taken from several sources, including member satisfaction surveys about medical care and customer service of the provider. Among other criteria, is also determined how often members of each plan have taken advantage of preventive screenings, checkups or vaccines, which treatments where used to manage members health conditions, pricing, the number of complaints that were filed and decisions appealed.

How To Enroll In And Switch To 5-Star Plans – Special Enrollment Period

5-Star rated plans have also the big advantage, that Medicare beneficiaries can enroll in/switch to at any time during the year also outside of the Medicare Open Enrollment period in fall of each year (Oct 15 – Dec 7). To do so you must only meet the requirements of the 5-star plan, meaning you must have Medicare Part A and B, live within the plan’s service area, and dont’ have end-stage renal disease.

It is a good idea to check your plan’s performance each year, and – if you find your plan in the low performers list – compare available alternatives that may better serve you. Medicare will also notify members of a consistently low performing plan that had less than 3 stars during the past 3 years, by mail, explaining their options to switch to a better rated plan.

More about Advantage Plans:

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By: Joseph Rosario