What to look for when you compare a Medicare Advantage health insurance plan

Once you’ve decided that a Medicare Advantage health insurance plan is your best option, you still have a tough decision to make. You are likely to find several such plans offered in your area, and they may look very similar at first glance. But as you peel back the layers and really look at the plan details, you will see that there are differences in how much they cost, how the services are delivered and measured, and how satisfied the members are with the service. 

So, how do you evaluate a Medicare Advantage plan?

Medicare provides the Star Ratings System to help you find the health and drug plans that fit your needs. The ratings measure how well Medicare Advantage and Part D prescription drug plans perform. People with Medicare, their families and their caregivers can use the ratings as an unbiased view to compare the quality of health and drug plans being offered in their area. 

Star ratings are perhaps the most underutilized resource when it comes to comparing Medicare Advantage plans. They are given out each year by the Centers for Medicare and Medicaid Services, the government body that oversees Medicare. A health plan’s rating is based on more than 50 quality and performance measures that fall into five categories, including quality of care and customer service. After the review process is complete, CMS awards plans a Star rating from 1 to 5, with 1 being “Poor,” 3 being “Average” and 5 being “Excellent.” 

The five categories in which health plans are rated include:

1. Staying Healthy
2. Managing Chronic Conditions
3. Member Experience with the Health Plan
4. Member Complaints and Changes in the Health Plan’s Performance
5. Health Plan Customer Service 

Medicare Part D drug plans are rated on how well they perform in four different categories, including:

1. Drug Plan Customer Service
2. Member Complaints and Changes in the Drug Plan’s Performance
3. Member Experience with the Plan’s Drug Services
4. Drug Safety and Accuracy of Drug Pricing 

Medicare gathers information on the plans from member surveys, information from clinicians and from the health plans, reviews of drug plan billing, and results from Medicare’s regular monitoring activities of the health and the drug plans. Plan ratings are updated every fall, and they may change from year to year. It is a good idea to check the Medicare Star Ratings every fall so you can make an informed decision about your coverage. 

As a general rule of thumb, plans with the higher ratings are likely to put more time and effort into member satisfaction, customer service and keeping their members healthy. Head to medicare.gov to easily compare how plans near you rate.