Medicare has released its grades for Medicare Advantage and Part D plans, and I was shocked. Tucson finally has four-star Medicare Advantage plans.
The ratings go from one star to five stars and are based on more than 30 criteria such as: member complaints; members leaving the plan; surveys of members and their satisfaction with the plan; telephone customer service; managing chronic illnesses of members; how many members get screening tests and flu shots.
As an insurance agent, I can’t name names, lest someone think I’m promoting specific Medicare Advantage plans. But I will say that the newly-crowned 4-star plans in Tucson are relatively new to town – and they are all under one company. I have heard both positives and negatives about this company and its plans. This company has a very interesting model of care, especially for people with chronic illnesses. Some doctor groups contracted with this company dropped out of the network in mid-year, leaving patients unable to see their doctor, who was then out-of-network. Many seniors enrolled with this company seem very happy with their plan and the attention they get from it. Some people have dropped, or will dis-enroll from these plans because they are unhappy with the network or the plan’s referral process. Please note that I am reporting what I have heard about these 4-star rated plans – both good and bad.
As with all Medicare Advantage plans, there are good things about them and bad things. Choosing an Advantage plan based on the star rating system alone will not work for most people.
The rest of the Medicare Advantage plans in town, at least those that have been around for some time, have improved their ratings from 3 stars to 3.5 stars. The higher scores are due to concerted efforts by the plans to please Medicare. For example, plans have been calling and writing their members to encourage them to get annual preventive screening tests that are provided at no cost. Medicare wants Advantage plans to spend money on their members to try to keep them healthy – and this is a good thing.
Phoenix has three Medicare Advantage plans that get 4.5 stars.
MORE STARS MEAN MORE MONEY
In 2012, the star ratings will be very important because Medicare will pay bonuses to Advantage plans that get three or more stars. Five-star plans will be able to enroll new members all year long. Unfortunately, Arizona doesn’t have any 5-star plans.
Fortunately for Arizona, 3-star and 3.5-star plans will get bonuses, because Medicare looked around and saw that most Advantage plans fall into this “average” range. The bonus rules were changed in order to keep the vast majority of Medicare Advantage plans in business. All Advantage plans are working hard to make improvements, with a goal of obtaining a 5-star rating (and higher bonus payments from Medicare). This is a good thing for people enrolled in Advantage plans.
The summary rating gives an overall score on the health plan’s quality and performance in 5 categories:
- Staying healthy: screenings, tests, and vaccines. Includes how often members got various screening tests, vaccines, and other check-ups that help them stay healthy.
- Managing chronic (long-term) conditions. Includes how often members with different conditions got certain tests and treatments that help them manage their condition.
- Ratings of health plan responsiveness and care. Includes ratings of member satisfaction with the plan.
- Health plan member complaints, appeals, and choosing to leave the health plan. Includes how often members have made complaints against the plan and how often members choose to leave the plan.
- Health plan telephone customer service. Includes how well the plan handles calls from members.
To see how Arizona Medicare Advantage plans are rated, use this link: Medicare.gov