Star Ratings are one of many things Medicare beneficiaries should consider when selecting a Medicare Advantage plan for 2019
BUFFALO, N.Y., November 16, 2018…The Centers for Medicare and Medicaid Services (CMS) recently released its annual Star Ratings to help Medicare beneficiaries assess the quality, value and performance of every plan throughout the nation. The release of this information coincides with this year’s Medicare annual enrollment period, which began on October 15 and runs through December 7.
Using a 5-Star Quality Rating System, with 5 being the highest-rated plan, all Medicare Advantage health plans and Medicare Part D prescription drug plans for 2019 received a rating from CMS. Independent Health’s Medicare HMO and PPO plans both earned 4.5 Stars for 2019.
The Medicare Star Ratings program was created 11 years ago; however, it wasn’t until 2011 that CMS began to assign overall ratings. The rating system measures Medicare beneficiaries’ experience with their health plans and the health care system. The key components that plans are measured on each year include:
- Screenings, tests and vaccines
- Managing chronic (long-term) conditions
- Customer service
- Patient safety and accurate drug pricing
- Member experience
- Member complaints, access and improvement
“With this year’s Medicare annual enrollment period currently upon us, the CMS Star Ratings serve as a helpful and unbiased way for Medicare beneficiaries to objectively compare their medical and prescription drug options for 2019 and choose the plan that is right for them,” said Cathy Aquino, director of government sales, Independent Health.
Do some homework before enrolling in a Medicare Advantage plan
In addition to looking at each health plan’s Medicare Star Ratings, Aquino suggests that Medicare beneficiaries consider the following additional tips when choosing a Medicare Advantage plan for 2019:
What type of plan best meets your health care needs?
Many health insurers offer different types of Medicare Advantage plans, with the two most common being:
- Health Maintenance Organization (HMO) plan – With this plan, you must use the doctors and hospitals that are in the HMO’s network. Many HMOs require their members to choose a primary care doctor affiliated with their plan. HMO plans typically have lower costs for doctor office visits than other types of plans.
- Preferred Provider Organization (PPO) plan – This plan gives you more flexibility when picking a doctor or hospital. Members of PPOs can seek medically necessary care either inside or outside of the network; however, their copayments, coinsurance and/or deductibles may be higher for services they receive outside the network.
Make sure you understand how the various plans work, especially if you travel frequently or are a “snowbird” with extended periods outside of the plan’s service area.
- Do your health care providers participate with the plan?
With some health insurers, provider participation varies by plan. You may have to pay much higher costs if your doctor or hospital are not part of the plan’s network. That’s why you should verify that your doctors and hospital are “in-network” by reviewing the plan’s provider directory, which lists all of the doctors and hospitals who participate in its network. This directory should be available on the plan’s website or by request.
- Are your medications included on the plan’s formulary?
Each plan has its own formulary, which is a list of all the prescription medications that it covers. Medications are typically grouped into tiers on a formulary. The tier that your medication is in determines your portion of the drug cost. Make sure you review the formulary to see if your medications are covered by the plan and how much you will have to pay.
- Will you have to pay more for certain benefits?
Some Medicare Advantage plans offer extra benefits like eye exams, dental care and hearing aids. Check if these benefits are included with your coverage. Also, find out if your optometrist/ophthalmologist, dentist and/or audiologist will accept this coverage.
- Will you get the support you need?
It’s important to find a plan that provides the one-on-one attention you deserve. See if your plan offers extended hours or convenient locations where you can go to get your Medicare-related questions answered? In addition, ask your family and friends what type of experience they’ve had with their plan. Were they satisfied with the level of customer service they received after they enrolled?