CMS Star Ratings: Keeping Insurers Focused on Improving Care for Members

Female doctor consults mature patient during the quarantine for coronavirus

There are online ratings for everything nowadays: restaurants, vacation rentals, nail salons, car mechanics, and doctors, just for starters. Thanks to the worldwide communication explosion, consumers have vast amounts of information at their fingertips. And although we may sometimes feel overloaded with choices, I consider these online ratings an overall positive step to help us make good decisions about how we spend our time and resources.

A Rating System for Medicare Advantage Health Plans

While it’s nice to check out ratings for a movie you’re on the fence about seeing, ratings and reviews can also be a tool for evaluating even more important areas…like your health care. Nowadays, even Medicare Advantage health plans are subject to the trend of being reviewed and rated.

The Centers for Medicare & Medicaid Services (CMS) issue an annual “report card” to all Medicare Advantage health plans through the Star Rating System. For Independence Blue Cross, this includes our Keystone 65 HMO and Personal Choice 65^SM PPO plans.

The rating system — which started in 2007 — has motivated Medicare Advantage health plans to continually improve to earn a high Star rating. CMS designed this system to improve health care quality and get a handle on ever-rising health care costs. CMS also grades hospitals and nursing homes using the Star Rating System.

I always tell members that the rating system isn’t perfect, but overall it can give a good sense of a health plan’s quality.

How Star Ratings Are Determined

Medicare Advantage plans that cover medical benefits are rated on measures in five categories, and plans that cover prescription drugs are rated on measures in four categories. Plans that offer both medical and prescription drug coverage are rated on all six categories, as shown below.


Category	Description	Medical Plans	Prescription Drug Plans

Staying healthy: Screening tests and vaccines	Whether members got various screening tests, vaccines, and other check-ups to help them stay healthy (for example, measuring how many eligible members received their preventive mammogram screening in a timely fashion).	✓
Managing chronic (long-term) conditions	How often members got recommended tests and treatments for their chronic conditions (for example, measuring how many diabetic members have their diabetes under control, as seen through blood test results).	✓
Patient safety and accuracy of drug pricing	How accurate the drug formulary and pricing are, and whether patients are taking their medications as prescribed.		✓
Member experience with the health or drug plan	Measured by responses gathered from an annual questionnaire mailed by CMS to a sample of enrollees in each ZIP code.	✓	✓
Member complaints and changes in the health or drug plan’s performance	How well the plan handles member appeals.	✓	✓
Health or drug plan customer service	How well the plan’s customer service department handles member questions.	✓	✓

In total, more than 40 different items within these categories are measured to determine a health plan’s Star rating.

You may have expected that we’d be rated on how well our customer service performs and how we administer benefits… but what you may not know is that we’re also accountable for the quality of care you get from your doctors and other health care providers in our network! We’re even rated on the customer service you get at the doctor’s office.

That’s just one of the reasons we take our Star rating so seriously. And, it’s a good reason you should, too.

In the End, Our Members Are at the Center of It All

Why should the Star Rating System be of interest to our members? In short, the better our Star rating is, the better the benefits we can offer members. Our Medicare Advantage health plans receive more financing for a higher Star rating, and that money must legally be used to improve the plan — either creating more robust supplemental benefits, reducing premiums, or decreasing your cost share. In the end, it means you can get more for your premium dollar.

Equally as important, the Star Rating System provides valuable information to help members choose the right plan for them — just like how restaurant reviews help you pick a place to eat. Enrollees can access Star Ratings on the CMS consumer website and compare plans from different insurers.

Members also gain the following additional benefits from the Star Rating System:

Enhanced relationships with their doctors
Improved access to care
Better customer service
Greater focus on early detection and prevention measures

This all boils down to the fact that a Medicare Advantage health plan is highly focused on its members receiving high-quality health care and excellent customer service.

And while you’re weighing your Medicare Advantage plan options, you might want to consider some new features we’ve added to our 2021 plans. For instance, vision, hearing, and dental coverage are included in every plan at no added cost. So is in-network COVID-19 testing and treatment. And you get a quarterly allowance you can spend on certain over-the-counter products. You can find out more about these new features here.

If you have any questions or concerns, always remember that we’re only a phone call away and we truly want to hear from you.

Website last updated: 11/13/2020
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Every year, Medicare evaluates plans based on a 5-star rating system.

Independence Blue Cross offers Medicare Advantage plans with a Medicare contract. Enrollment in Independence Medicare Advantage plans depends on contract renewal.

Independence Blue Cross offers products through its subsidiaries Independence Hospital Indemnity Plan, Keystone Health Plan East and QCC Insurance Company — independent licensees of the Blue Cross and Blue Shield Association.