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
-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!