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How Does Medicare’s Plan Ratings System Work?

Medicare open enrollment has been underway since mid-October. And at this point, existing enrollees only have a few weeks left to make changes to their coverage for 2024.

If you're new to open enrollment, you may be wondering how to approach the process of selecting a new Medicare plan. And one tool that might help you navigate your choices is Medicare's plan ratings system, which you can access when you use the program's plan finder.

A person at a laptop.

Image source: Getty Images.

If you're not familiar with Medicare's plan ratings system, here's what you need to know.

It's a really easy system to follow

Medicare uses a star ratings system to compare Part D drug plans and Medicare Advantage plans. A one-star rating is the lowest score a plan can get, while a five-star rating is the highest.

There are different criteria for rating Medicare plans. For a Medicare Advantage plan, the ratings system considers how well plans:

  • Support enrollees in staying healthy via screenings, diagnostics, and preventive care
  • Help enrollees manage chronic health conditions
  • Provide helpful customer service and handle member complaints

For Part D drug plans, the rating system considers how well plans:

  • Help enrollees manage their prescription needs and costs
  • Provide helpful customer service and handle member complaints
  • Make drug pricing transparent and easy to follow

Medicare star ratings also account for how many enrollees leave the plan in question. A large number of people who opt to disenroll in short order will bring down a given plan's rating.

You should also know that plans with consistently low ratings are flagged by Medicare, and that will come up when you use the program's plan finder to see what choices are available to you.

Medicare should also inform you if the plan you're enrolled in has been flagged.

This doesn't mean Medicare will cancel your coverage under that plan. Only you can make that decision. But it should keep you in the loop so that you can make a sound decision.

Look at the big picture

Medicare's plan ratings can help you narrow down your choices and potentially be a tie-breaker if you're torn between two seemingly comparable plans. But to be clear, you want to look beyond those ratings when making your choice.

The most important factors to consider when choosing a Medicare plan are the costs you'll face and the coverage you'll get. A plan with a five-star rating may not do you much good if the cost just doesn't work for you, or if, in the case of an Advantage plan, a benefit you need isn't offered.

All told, Medicare's plan ratings system is extremely easy to follow. But if you haven't yet started reviewing your options for Medicare coverage in 2024, it's best to get moving right away.

Open enrollment ends on Dec. 7. If you don't make changes to your coverage by then, you'll be stuck with your existing plan. That may or may not be a bad thing, but it's important to see what your options look like even if you're reasonably happy with the plan you have already.

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The post How Does Medicare’s Plan Ratings System Work? appeared first on Retirely.

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