The Health Care Reform Law will be cutting payments to Medicare Advantage plans, but some plans may actually get more money – if they are highly-rated, meaning they are the best of the best when it comes to patient care, illness prevention, and customer satisfaction.
Unfortunately, the Medicare Advantage plans we have in Tucson are not highly-rated.
If you go to Medicare.gov and click on “compare health plans”, you will be asked to enter a zip code. Put in any Tucson zip code and you will get a list of all the Medicare Advantage plans offered in Pima County (or any county in the country based on the zip code you use). The rating system is based on five stars:
5 = excellent
4 = very good
3 = good
2 = fair
1 = poor
No Tucson Medicare Advantage plan is rated higher than 3 stars, meaning our plans are okay but not great. Health Net and Secure Horizon plans get 3 stars, while Humana and Evercare get 2.5.
In Phoenix, the Cigna Medicare Advantage Plan gets 4.5 stars. This is better than Kaiser in California, which gets 4 stars. I mention Kaiser because their plans, where doctors are employed by Kaiser, are supposed to be the standard bearer for managed care plans.
CareMore in California gets 4.5 stars for all its Advantage plans, most of which are for people with chronic illnesses such as heart disease, diabetes, and breathing disorders. The CareMore plans in Tucson are too new to be rated as this is their first year in operation here.
I read somewhere that long-running Medicare Advantage plans tend to be the better plans, so I don’t know why our Tucson plans are merely “good”. Tucson has had Medicare HMO plans since the early 1990′s and in a March, 1996 article, The New York Times said Tucson’s Medicare HMO plans would be the model for saving Medicare. I wonder what happened in Tucson? Getting 2.5 and 3 stars is not going to gain our Medicare Advantage plans any favors from Medicare when it comes time for payment cuts.
The Medicare.gov website explains the ratings:
This summary rating gives an overall score on the health plan’s quality and performance on 33 different topics 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.
The information described above is gathered from several different sources. In some cases it is based on member surveys, information from clinicians, or information from plans. In other cases it is based on results from Medicare’s regular monitoring activities.
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