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CMS Star Rating


The Centers for Medicare & Medicaid Services (CMS) uses a five-star quality rating system to measure Medicare beneficiaries’ experience with their health plans and the health care system. This rating system applies to Medicare Advantage plans that cover both health services and prescription drugs (MA-PD). The ratings are posted on the CMS consumer website, www.medicare.gov, to give beneficiaries help in choosing an MA and MA-PD plan offered in their area. 5 Stars is the highest rating a health plan can receive with 1 Star being the lowest. The Star Rating program is designed to promote improvement in quality and recognize primary care providers for demonstrating an increase in performance measures over a defined period of time.

The Overall Star Rating gives an overall rating of the plan’s quality and performance for the types of services each plan offers. For plans covering health services, this is an overall rating for the quality of many medical/health care services that fall into 5 categories:

  • Staying healthy: screening tests and vaccines. Includes whether members got various screening tests, vaccines, and other check-ups to help them stay healthy.
  • Managing chronic (long-term) conditions: Includes how often members with certain conditions got recommended tests and treatments to help manage their condition.
  • Member experience with their health care Providers and their Health Plan: Includes member ratings of the member experience with various aspects of treatment , care and services provided by the Health Plan and Providers.
  • Member complaints and changes in the health plan’s performance: Includes how often Medicare found problems with the plan and how often members had problems with the plan. Includes how much the plan’s performance has improved (if at all) over time.
  • Health plan customer service: Includes how well the plan handles member appeals.

For plans covering drug services, this is an overall rating for the quality of prescription-related services that fall into 4 categories:

  • Drug plan customer service: Includes how well the plan handles member appeals.
  • Member complaints and changes in the drug plan’s performance: Includes how often Medicare found problems with the plan and how often members had problems with the plan. Includes how much the plan’s performance has improved (if at all) over time.
  • Member experience with plan’s drug services: Includes member ratings of the plan.
  • Drug safety and accuracy of drug pricing: Includes how accurate the plan’s pricing information is and how often members with certain medical conditions are prescribed drugs in a way that is safer and clinically recommended for their condition.

Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.

Our plan is too new to be measured. CMS will update our Star Rating in October 2018. CMS will publish the Star Ratings for each Medicare Advantage organization on October 11, 2018, based on the 2017 calendar year data.