CMS: Medicare Advantage beneficiaries enrolled in top-rated plans will rise in 2019

Read Advisory Board's take: What does this mean for plans competing in the MA market?

Nearly three-quarters of Medicare Advantage (MA) beneficiaries with prescription drug coverage will be enrolled in plans with four- or five-star ratings for the 2019 coverage year, according to CMS quality star ratings data released Wednesday, HealthPayerIntelligence reports.

Medicare's 2019 open enrollment period for health and drug plans launched Oct. 15 and is scheduled to end Dec. 7.

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 bonuses in their monthly per-member Medicare reimbursements.

Data show more beneficiaries will have access to top-rated MA plans

CMS said MA beneficiaries will be able to choose from 3,700 for the 2019 coverage year, up from about 3,100 for 2018. According to CMS, individuals in each state will have access to at least 10 MA plans.

CMS estimated that 74% of MA beneficiaries with prescription drug coverage will be enrolled in MA plans with four- or five-star ratings for 2019, up from 73% in 2018. CMS said about 45% of MA plans that also offer Part D coverage will have an overall rating of four or more stars for 2019.

The data show 19 MA and Medicare Part D plans for 2019 have five-star ratings, including 14 that offer both MA and Medicare Part D coverage, four that offer just Medicare Part D coverage, and one that offers just MA coverage.

Fewer plans earned five-star ratings for 2019 than in 2018, HealthPayerIntelligence reports. According to CMS, just four MA plans earned overall quality ratings of 2.5 stars of lower for 2019.

In addition, the data show fewer standalone Medicare Part D plans received four- or five-star ratings for 2019 when compared with 2018. According to the data, 31% of Medicare Part D plans received a rating of at least four stars for 2019, and CMS estimates that a majority of beneficiaries will be enrolled in Part D plans with a rating of at least 3.5 stars for the 2019 coverage year.

CMS Administrator Seema Verma said, "[MA] enrollees will continue to have access to high quality plans while plan choices are increasing and premiums are declining" (Beaton, HealthPayerIntelligence, 10/11; Haefner, Becker's Hospital Review, 10/11; Heath, PatientEngagementHIT, 10/11; Sweeney, FierceHealthcare, 10/10).

Advisory Board's take

Rachel Sokol, Practice Manager, and Natalie Trebes , Consultant, Health Plan Advisory Council

As many of CMS' star measures rely on plans' abilities to collaborate effectively with clinicians to close care gaps, it's not surprising that integrated plans like Kaiser are heavily represented among the top star performers.

“MA plans will soon have much broader opportunities to attract and manage beneficiaries”

With more MA products offered every year and increasingly lower premiums, the MA market has become highly competitive. That's a challenging environment for new plans hoping to capitalize on one of the biggest—and only—organic growth opportunities in health insurance today.

Successful MA plans must compete on both quality and cost—and make sure their prospective enrollees understand their unique advantage. And with the new benefit flexibilities CMS introduced earlier this year, MA plans will soon have much broader opportunities to attract and manage beneficiaries in 2019. In particular, plans will soon gain greater ability to build value-based benefit designs for specific populations. In addition, the scope of supplemental benefits will broaden to include items or services that:

  • Compensate for physical impairments;
  • Diminish the impact of injuries or health conditions; and/or
  • Reduce avoidable emergency room utilization.

That means services like home health workers, and equipment such as portable wheelchair ramps will soon be covered. But effectively deploying these new flexibilities will depend on plans' abilities to personalize products at scale. To do so, they'll need to convey their targeted products through marketing; guide each member's personalized use of custom services and supports; and efficiently procure those benefits from new types of provider and community partners.

With so much new territory to pursue, it's likely that stars will ultimately become the baseline for competitive products—not the height. For plans seeking to propel their quality performance forward, we suggest accessing our Medicare Advantage Stars Improvement Guide, which provides improvement strategies best suited for each specific star measure.

Get the Guide


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