Medicare Advantage Star Ratings Increasing Overall Plan Quality

Quality in Medicare Advantage plans is increasing, and CMS credits the improvement to its star rating system. A growing number of Medicare enrollees are in plans receiving at least 4 out of 5 stars, according to a new fact sheet.

Quality in Medicare Advantage (MA) plans is increasing, according to a CMS fact sheet on the results of the 2015 star ratings. A total of 16 plans earned 5-star ratings, 11 of which are MA with prescription drug coverage (MA-PD), 2 are MA only, and 3 are Prescription Drug Plans (PDPs).

On average, MA-PD plans received 3.92 stars (weighted by enrollment), which is an increase from 3.86 in 2014. The average rating for PDPs is up to 3.75 from 3.05 in 2014. CMS made it clear that it credits the star rating system with the improved quality of MA plans.

“Star Ratings are driving improvements in Medicare quality,” the fact sheet notes.

Furthermore, 53% of PDP enrollees and 60% of MA-PD enrollees are in plans with 4 or more stars, up from 9% and 52%, respectively, in 2014. In addition to an increase in the number of beneficiaries in high-performing MA plan, there was a dramatic improvement in low-performing plans. Low-performing plans received consistently low quality ratings in the past 3 years.

“CMS saw dramatic improvement among plans that received the low performing icon (LPI) in 2014, and many are not receiving an LPI for 2015,” according to the fact sheet from CMS.

Compared with last year, there was an 80% reduction in the number of contracts receiving an LPI for the 2015 star ratings. In 2014, 39 contracts received an LPI and consequently 65% of those that did not withdraw from the program improved their ratings.

Overall, non-profit organizations tend to receive higher ratings than for-profit ones, according to the data from CMS. Among the 14 MA-PD and the PDP contracts that received 5 stars, only 1 was a for-profit organization.

Another factor influencing star ratings was experience within the MA program. All but 1 of the MA-PD 5-star plans have been participating in the program for greater than 10 years. All of the PDP 5-star plans have been part of the program for between 5 and 10 years.

Read the full CMS fact sheet: http://bit.ly/1w8FlKz