When the government (the Centers for Medicare and Medicaid (CMS)) started rating insurance plans on a 5 star system 9 years ago, everyone yawned.  But of course, when big incentive dollars became attainable, everyone sat up and took notice.

Plans with 4 stars earn a 5% bonus to their monthly per-member payments

When my clients leave the hospital they often call me and ask if they are required to fill it out a lengthy survey they received from Medicare. CMS uses these surveys to grade the carriers and hospitals, and no, they are not mandatory.

CMS released their 2018 Star Ratings this week and it is interesting to decipher the data:
  1. The number of 5 star plans, our Gold Star Performers, didn’t change from last year. There are still only 23 plans. These plans can sell all year long.
  2. CMS used to terminate plans that had 3 out of 5 stars for 3 years or longer, which caused a lot of confusion in the market. They stopped terminating plans for low stars but with less reimbursements they are forced out of the market anyway.
  3. There are 61 plans with 3 stars and 2 with 2 1/2 stars (Phoenix Health Plans and GHS Managed Health Care).
  4. Five Star Plans decreased from last year slightly but in general, the amount of members in 4+ star plans increased from 69% to 73%.

How does this ranking impact the member?

More stars = More money = Better benefits and more price stability

  • Humana’s number of 4 star plans dropped in 2017, but are back up for 2018.
  • Anthem has its first 5 star plans (Georgia, Kentucky and New Hampshire) to celebrate.  Overall has 60% of it’s members are in plans over 4 stars.
  • Centene dropped due to a problem with a carrier it purchased that had an audit penalty from 2015.  Cenente has said it plans to appeal the rating of 3 1/2 stars.

Agents are required to tell every prospect the star ratings of the MAPD and PDP plan as part of a compliant presentation.  Agents must also give two criteria the ratings are based on, such as customer service, how well a plan handles client appeals and management of chronic diseases.  Part D is also included in the star ratings.  Drug pricing, drug safety and how well Medicare beneficiaries respond to drug treatments all weigh in. some think PDP is weighted too heavily.

You can see how CMS weighs the measurements here.

“I see that my plan has a low star rating, should I change plans?”

I always tell my clients if they are happy with their plan, there is no need to change. If they are using it and they like the service, access to providers and overall experience, then stay with it.

What can an insurance agent do to help improve star ratings? Cultivate happy clients.

When agents get sales complaints, that translates into the stars.  Sometimes people complain because they are confused, and a quick response from their agent prevents the client from calling into Medicare.  If you have ever “Secret Shopped” Medicare (which I recommend you do for the experience), you may find, as I did, that their staff seem to steer the caller to file a complaint – when really they just need a clarification. 

I ask, plead and almost beg my clients to CALL ME FIRST if they have a question about Medicare or Part D plans.  One of the nicest things about people over 65 is their compassion. “Oh honey, I hate to bother you, I know you are so busy.”  I freely give out my cell phone and tell them to promise to call me first.  I will give them a quicker answer and in most cases, a more accurate answer!  And…I stress that it is never a bother.  Medicare is confusing and the constant changes are frustrating, be responsive to your client’s questions and we can all help the star rating improve.