What Is a 5-Star Medicare Advantage Plan and What Does the Star Rating Mean?

In today’s global scenario, health care is becoming more expensive by the day. The pandemic has completely changed the way safety and prevention protocols operate. With a general decline in the quality of health and lifestyle, it is becoming increasingly important to be financially stable with medical care. Medicare has become a mandatory investment to ensure that quality health care can be obtained whenever required. It is primarily for people aged 65 and above, but it also covers younger people with disabilities and end-stage renal diseases.

What Makes a Medicare Advantage Plan 5 Stars?

Medicare plans are provided by Original Medicare, Health Maintenance Organizations (HMO), and Preferred Provider Organizations (PPO). Private companies receive a fixed amount every month for different Medicare plans and charge the policyholders with deductibles or out-of-pocket expenses. Every plan and every source from which you can obtain the plan differs. It is important to know what services each plan provides and what they do not.

Services Provided

Most Medicare plans offer Part A and Part B services. Part C refers to Medicare Advantage plans that are offered by private companies registered with Medicare. Other services include drug coverage, a savings plan, and care for the elderly as well.

Part A:

Covers inpatient hospital stays, skilled nursing care, hospice care, and limited home health care.

Part B:

Covers doctor’s visits, outpatient procedures, diagnostic tests, medical supplies, and preventive services, including certain screenings.

Part C:

“Part C” is also known as the Medicare Advantage plan.

Part D:

Covers prescription drugs, based on the availability in the area and priority

High Deductible Health Plan:

Covers your costs only after you cross a pre-set yearly deductible amount

PACE:

All-inclusive care for the elderly includes home care, prescription drugs, nursing care, and nutritional counseling.

Part A is usually free, whereas a monthly premium is necessary for Part B. Medicare usually covers about 80% of the health care costs, and the remaining 20% is in the form of deductibles, coinsurance, or out-of-pocket expenses. Unless you enroll in a Medicare Advantage plan, you must pay an additional premium for Part D plans. Private companies also provide additional services such as Supplemental Insurance Policies or Medigap to account for any services other than those provided in Medicare. An additional premium is required.

Choosing the Right Plan

Barring a few basic plans, the services provided vary depending upon the area, the provider, and the health care facilities available. The best plan is the one that suits your personal requirements. Some plans cover cancer treatments, whereas others provide high-cost coverage for diabetes. Finding out the facilities available, healthcare professionals available, and getting opinions from registered plan holders can prove to be extremely beneficial. Ultimately, the purpose of the plan is to help you manage the expenses and, at the same time, ensure quality health care.

Medicare Advantage

Also referred to as the Part C Medicare plan, it is provided by private companies that are approved by original Medicare. They use local network providers to provide these plans, which vary from one place to another. This plan includes Part D as well, which covers prescription drug usage apart from Part A and Part B services. Additional features include vision or dental. However, the Medicare Advantage plan does not work with Medigap or supplemental insurance policies.

Most commonly, they are considered an alternative to original Medicare. The most common types of Medicare Advantage plans are HMO plans and Special Needs Plans (SNPs). The only two criteria required to enroll in a Medicare Advantage plan are the availability of the plan in that area and having Medicare Parts A and B. A cost comparison should be made between a Medicare Advantage plan and an original Medicare plan with Medigap and Part D enrolment. Like other types of health insurance, each Medicare Advantage plan has different rules about coverage for treatment, patient responsibility, and costs.

Despite their many advantages, Medicare Advantage plans have a few drawbacks as well. One should ensure that the required drugs are covered under the prescription drug plan. Policyholders can only avail the services of the doctors or hospitals in the provider’s network. They might have to pay out of pocket fully or a greater percentage of the expenses to consult a preferred doctor or a trusted laboratory. Compared with other Medicare plans, Medicare Advantage has greater co-pays, which could defeat the purpose of having medical coverage.

5-Star Rating and Its Significance

In simple words, ratings are a measure of how good or bad a service is. Health insurance plans also have ratings that are measured based on certain factors that assess the quality of the plan. The rating scale is numbered from 1 to 5 as follows:

1 star – poor

2 stars – below average

3 stars – average

4 stars – above average

5 stars – excellent

These ratings are given by Medicare, and a 5-star Medicare Advantage plan is believed to have the highest quality rating broadly based on customer satisfaction and access to needed health care. It is an essential criterion to consider while choosing a Medicare plan. If a 5-star plan is available in your location, you are qualified for a special enrolment period that allows you to switch to a 5-star plan at any point during the year.

A star rating is a weighted average of several different parameters and outcome measures. For a Medicare Advantage plan, 40 measurements are taken into consideration – 12 for Part D and 28 for Part C. The measurements are divided into 5 broad categories, and each measurement carries a certain number of points:

• Customer satisfaction (2 points each)
• Frequency at which preventive care is used (1 point each)
• Improvement measures (5 points each)
• Access to care and service (2 points each)
• Quality of care (3 points each)

As mentioned earlier, the Part C star rating takes into consideration 28 individual measurements, of which patient experience is the most important one. It also takes into consideration complaints, getting appointments, and the quality of health care. When it comes to the star rating for Part D, 12 measurements are considered. Health outcomes contribute the most to the success of the prescription plan, with close tabs on the percentage of adherence to the prescribed drug protocol.

Thus, it is vital to consider the type of coverage required, mode of health care, availability of health professionals, adequate laboratory services, and preventing financial strain before choosing a Medicare plan. Consulting professional insurance companies goes a long way in helping you make an informed decision.

If you are looking for the best health insurance plan that suits you, DeverCare is a choice that you will not regret. We have brokers with high expertise in the Medicare industry to find the right insurance for you within your budget! We can also help you switch from your current Medicare plan to a Medicare plan with a 5-star quality rating if a Medicare Advantage Plan, Medicare Drug Plan, or Medicare Cost Plan with a 5-star rating is available in your area. Contact us today for more information and quality insurance services!