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October 12, 2017

CMS rates 23 MA and Part D plans as 'five-star'

Daily Briefing

    About 73 percent beneficiaries with Medicare Advantage (MA) plans that have both medical and drug coverage in 2018 will be enrolled in plans with four or more stars, according to CMS star ratings data released Wednesday.

    About the star ratings system

    CMS' star ratings system scores MA and Medicare Part D plans on a scale of one to five, with five representing top-performing plans. CMS' MA plan star ratings are based off of several factors, including:

    • Access to care;
    • Clinical outcomes, including hospital readmissions; and
    • Customer service quality.

    Plans that earn four or more stars receive a 5 percent increase in their monthly per-member Medicare reimbursements.

    2018 star ratings

    In the latest ratings, 44 percent of the 384 MA contracts offering prescription drug coverage for the 2018 coverage year received four or more stars. By comparison, about 50 percent of active 2017 MA plans that offer prescription drug coverage received at least four stars. According to Modern Healthcare, 23 MA and Part D plans will have five stars for 2018, the same number as in 2017.

    The average MA plan received a 4.06 rating for 2018, compared with a 4.02 average for 2017 MA plans. Among Medicare plans that offer only Part D prescription drug coverage, the average rating increased from 3.55 last year to 3.62 for 2018. CMS said about 52 percent of standalone Medicare Part D plans will have four or five stars in 2018. The percentage of beneficiaries enrolled in standalone Medicare Part D coverage with four or five stars will increase from about 41 percent in 2017 to 47 percent in 2018.

    In a release, CMS said the number of MA plans sold throughout the country increased to more than 3,100. CMS said more than 85 percent of Medicare beneficiaries will have access to at least 10 MA plans.

    Premiums to decline

    Further, CMS estimated that the average monthly premium for an MA plan will fall by about 6 percent, or $1.91, compared with 2017. CMS said 77 percent of MA beneficiaries who remain in their current plan will have the same or lower premiums for the 2018 coverage year.

    CMS also said that the average basic premium for a Medicare Part D plan in 2018 is expected to decrease by $1.20, compared with 2017 (Clason, "TrumpTracker," CQ HealthBeat, 10/11; Beaton, HealthPayer Intelligence, 10/11; Haefner, Becker's Hospital Review, 10/11; Castellucci, Modern Healthcare, 10/11; Morse, Healthcare Finance, 10/11; CMS fact sheet, 10/11; CMS release, 10/11).

    Help patients plan for out-of-pocket expenses

    The rising cost of prescription drugs is placing an increasing financial burden on patients, in many cases leading them to delay or forgo care or default on their medical bills.

    Join us on Tuesday, Oct. 24 to learn best practices for helping patients understand their insurance coverage, estimate and plan for their out-of-pocket expenses, and secure copay assistance or drug replacement.

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