October 16, 2019

More than three-quarters of Medicare Advantage (MA) beneficiaries with prescription drug coverage are expected to enroll in plans with four- or five-star ratings for the 2020 coverage year, according to CMS quality star ratings data released Friday.

Get 1-page cheat sheets on how hospital quality ratings programs work

Medicare's 2020 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 have about 1,200 more plans to choose from for the 2020 enrollment period, compared with the 2019 enrollment period. .

CMS estimated 81% of MA beneficiaries with prescription drug coverage will enroll in MA plans with four- or five-star ratings for 2020. CMS said about 52% of MA plans that also offer Part D coverage will have an overall rating of four or more stars for 2020—up from 45% in 2019. CMS said it expects about 28% of beneficiaries will enroll in stand-alone prescription drug plans with four- or five-star ratings.

According to CMS, the average star rating for MA plans with prescription drug coverage has increased from 4.02 for 2017 to 4.16 for 2020, and the average star rating for stand-alone prescription drug plans has increased from 3.34 for 2019 to 3.5 for 2020.

The data shows 23 MA and Medicare Part D plans for 2020 have five-star ratings, including 20 that offer both MA and Medicare Part D coverage, two that offer just Medicare Part D coverage, and one that offers just MA coverage.

CMS warned five insurers with health plans covering more than 73,000 beneficiaries—Delaware Life Insurance Co., Centers Plan for Healthy Living, Magellan Health, QHP Financial Group, and Universal Health Services—for consistently receiving low quality ratings, Modern Healthcare reports. CMS said the plans have earned 2.5 stars or lower for an MA or Part D plan since at least 2018 (Minemyer, FierceHealthcare, 10/11; Kim Cohen, Modern Healthcare, 10/11; Haefner, Becker's Payer Issues, 10/11; CMS release, 10/11).

Get 1-page cheat sheets on how hospital quality ratings programs work

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