[Podcast] Understanding Medicare Star Ratings - Medicare Simplified

In this episode of Medicare Simplified, we focus on what is a star rating and how they can assist you in sorting through your coverage options.




Courtney Collen (host): Hi, welcome to Medicare Simplified, a podcast by Sanford Health Plan to help you decide which Medicare options are right for you. I'm your host, Courtney Collen. You might be hearing or reading about star ratings when it comes to Medicare Advantage plans. I have Jack Arnett who is the Inside Sales manager at Sanford Health Plan joining me now to help break down what this means, what it is and how important it is. Jack, thank you for joining me.

Jack Arnett (guest): Thank You, Courtney. Pleasure to be here.

Courtney Collen (host): So let's start with the first question. What is a star rating?

Jack Arnett (guest): Sure. The Centers for Medicaid and Medicare Services (CMS), some people just refer to it as Medicare, uses a star rating system to measure how well Medicare Advantage plans perform using a variety of categories and a variety of different things to measure Medicare Advantage plans. They'll rank a plan on a scale from one to five. Five being the highest rating you could get, one being the lowest. And star ratings help consumers compare the quality of health and drug plans in their particular area. The Centers for Medicare and Medicaid Services (CMS), releases these each fall, and our latest ratings just came out a few weeks ago.

Courtney Collen (host): So why does this matter, or how can it help in choosing a plan?

Jack Arnett (guest): Well, I think with any purchase, whether it's a Medicare Advantage plan or any consumable or commodity, we're very concerned about quality.

Jack Arnett (guest): Most individuals when it comes to Medicare Advantage plans have a good grasp on premiums, on benefits, on cost shares and on networks, but the star ratings and the quality aspect of Medicare Advantage sometimes get missed or are not fully understood. So, for consumers when you're reviewing plans, amongst all the other things, you would consider the quality of a plan – and this is Medicare's ranking. This isn't ours. This isn't an independent entity giving us a ranking that maybe an insurer would pay for. This is Medicare's actual rating of the Align plan.

Courtney Collen (host): What are CMS star ratings based on? Let's talk about some of those key factors impacting medical star ratings.

Jack Arnett (guest): Sure. I kind of put them into three different categories. There are actually 40 unique quality and performance measures. These refer to HEDIS and CAPs. CAPs is a survey that members and enrollees complete and send back to us. Some of the measures are based on screenings and tests, or what we call the health side of breast cancer screenings, colorectal cancer screenings and flu vaccines – things that are very important to Medicare beneficiaries. How does the plan care for older adults when it comes to medication review, pain management, diabetes, eye care and blood sugar control? Other measures, Courtney, are based on managing chronic conditions, long-term conditions like the risk of falling, transition of care, and follow-up after emergency department visits with people who are high risk. And then there's kind of the third bucket, what we call the non-health care related categories like our customer service department. How do we handle complaints and appeals?

Jack Arnett (guest): How are we set up to deal with any foreign language needs or hearing-impaired needs? These are just some of the highlights, Courtney, but there are 40 different measures that Medicare uses to put these star ratings together.

Courtney Collen (host): Well, thanks for walking through a few of those. Jack, where can I find information on my plan’s star rating?

Jack Arnett (guest): Sure. They can be found most commonly on medicare.gov. And that's the source of truth for so many things when it comes to Medicare beneficiaries whether you're looking for star ratings of plans and plans that are available in your local area. It's right in the middle when you go to medicare.gov. There's a plan finder locator tab. You just click on that and put in your zip code. It'll list every plan available to you in that zip code. And right on that page next to the name of the plan, it'll give their star rating.

Courtney Collen (host): Okay. Easy enough. And Jack, with this information about star ratings, if we want to learn more about it, about an Align or Sanford Health plan in general, where can we start?

Jack Arnett (guest): Sure. Well, first of all, we are right in the middle of Medicare's annual enrollment period, which began on October 15th and runs through December 7th. During this time, Medicare beneficiaries have the opportunity to enroll in their current coverage or they can make as many plan choices and changes as they would like. The last one they do will take effect on January 1st. With Align powered by Sanford Health Plan’s star rating that just came out a few weeks ago, perhaps a lot of local Medicare beneficiaries aren't aware of that. Courtney, there are a lot of plans to choose from. And there are a lot of good options for Medicare beneficiaries to take a look at. But we are one of the very few plans that have reached the star rating that we have, and that's four and a half out of five stars.

Jack Arnett (guest): We are just so proud of that at the health plan. Generally, it takes several years for a health insurance company, a Medicare Advantage organization, to even come close to that. There are 545 different Medicare Advantage plans. A little over 4% actually achieve that four-and-a-half out of five-star rating in less than five years, and we are one of them. And so that just speaks volumes to the quality of the plan, to the quality of the individuals that are leading this plan. Everything from the initial sales and enrollment through claims, through our utilization management, to our medical review and our medical directors, all the way up to the leadership of the health plan. So it is a huge accomplishment. We're very, very proud of that.

Courtney Collen (host): Well, such great news, and we appreciate your time and walking us through what that means and just the significance of it all. Thank you, Jack. Learn more about the questions to ask to find a plan that fits your needs at align.sanfordhealthplan.com. I'm Courtney Collen with Sanford Health News.


Align powered by Sanford Health Plan is a PPO with a Medicare contract. Enrollment in Align powered by Sanford Health Plan depends on contract renewal. Sanford Health Plan complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, or any other classification protected under the law. This information is not a complete list of benefits. Call (888) 605-9277 ( TTY: 711) for more information.

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