CMS Star Ratings a BIG Deal in 2012

  • Originally published December 9, 2010 , last updated April 3, 2018
CMS Star Ratings a BIG Deal in 2012

CMS Star Ratings a BIG Deal in 2012

Chance at Special Election Period and more money in 2012 has MA carriers banking on CMS Star Ratings.

CMS recently announced that, starting in 2012, it will create a Special Election Period (SEP) that allows Medicare beneficiaries to enroll in 5-star Medicare Advantage plans at any point during the year.

The same star ratings, which are found on Medicare’s Plan Finder, will also influence carrier reimbursement rates starting in 2012. Carriers with higher star ratings will receive High-Performer Bonuses and High-Performer Rebates from CMS as an incentive to adhere to quality standards.

Put simply, A LOT is riding on these quality ratings for the carriers. Here is what is at stake:

5-Star Rating (Excellent)

Medicare beneficiaries will be eligible to enroll in 5-star plans year-round through a Special Election Period (SEP).

Who will be eligible for this SEP?
1. Beneficiaries enrolled in MA plans with a star rating of 4.5 or less.
2. Beneficiaries who are enrolled in Original Medicare and meet the eligibility requirements for Medicare Advantage.

Part D status will not be a factor in determining eligibility for this SEP. Effective dates for enrollments made under this SEP will be the first of the month following the month the enrollment request is received.

Additionally, plans garnering a 5-star rating will be eligible for the largest bonuses—equal to 5%, according to CMS.

4-Star Rating (Very Good)

Carriers receiving a 4-star rating or higher will also be eligible for additional bonuses and reimbursements, but they will not be able to be sold year-round. Right now, only one in four Medicare Advantage plans garner a 4-star rating. The average rating for a Medicare Advantage plan is 3.27 stars.

3-Star Rating (Average)

According to CMS, all Medicare Advantage plans that have a score of 3 stars and higher will qualify for a bonus payment in 2012, but they will not be able to be sold year-round.

1-Star (Fair) & 2-Star Rating (Poor)

Plans that score less than 3 stars will not be eligible for a bonus and if they’ve maintained those low scores for the past three years, a “low performer” icon will be placed next to the names of those plans on

Star ratings are based on 53 quality measures that rate health plan quality and performance in five main categories:

1. Staying healthy: screenings, tests, and vaccines
2. Managing chronic conditions
3. Ratings of Plan responsiveness and care
4. Plan member complaints, appeals, and disenrollment
5. Telephone customer service

Looking at the criteria above, agents can expect increased focus from the carriers on disease management, preventive care, agent compliance and customer service. We’ve been saying it for years, but it’s truer now than ever: it pays to run with the best.

2011 Star Ratings were released November 10th and can be found on the Plan Finder at Plan ratings for the 2012 plan year will be published in the fall of 2011, prior to the annual election period (AEP).