The latest Medicare star ratings are available for Medicare Advantage plans – and there are changes for plans in Tucson. One company’s plans that received 4 stars for 2012 are now rated 3.5.  Health Net plans are now rated 4 stars, the highest in town.  The ratings are based on data from 2011 for some plans and early-2012 for others.

Here is a list of plans available in Tucson, AZ and their star ratings (out of a possible 5 stars).

CareMore Value Plan:  3.5 stars
CareMore StartSmart: 3.5 stars (This is new to Tucson for 2013, so how is it even rated???)

Health Net Ruby 1 and 4: 4 stars
Health Net Jade:  4 stars
Health Net Ruby Select: 4 stars (This plan is not even in place until January 2013, so how is it rated?)

AARP Medicare Complete Plus:  3.5 stars
AARP Medicare Complete 1: 3.5 stars

Humana Readers Digest… HMO:  3.5 stars
Humana Regional PPO ($154/month): 3.5 stars
Humana Local PPO ($92/month): 3 stars

SCAN:  3 stars

Abrazo: 2.5 stars (This plan does not yet exist in Tucson, so the rating must be based on their plans in Phoenix.)

Universal Any Any Any PFFS: 2 stars
Universal Hassel-free PPO: too new to be measured

So how do they come up with these scores? Here is a list of some of the things that are considered:

-Screenings received by plan members for:  breast cancer, colon cancer, cholesterol, diabetes, glaucoma, osteoporosis
-Flu vaccines received by plan members
-Medication reviews received by plan members
-Customer Service
-Getting appointments and care quickly
-Complaints about the health plan
-Members choosing to leave the plan
-Plan makes  timely decisions about appeals

Complaints and people leaving the plan are the most important rating factors for me.  Getting appointments and care quickly seems to be beyond the control of most Advantage plans (in my opinion).  Most Advantage plan are insurance companies that contract with doctors.  So how can Advantage plans control doctors’ schedules when the doctors are not their employees?

As for all those screening tests:  If you wondered why your Medicare Advantage plan has been calling you about getting a flu shot or mammogram, now you know. Medicare is grading the plans on how many of their members get preventive screenings and tests.  So be a good team member and get that flu shot! Your plan needs your help!

Go to Medicare.gov and use the Plan Finder to compare plans.  The star rating data can be found on the CMS website.

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