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  5. Medicare Star Ratings: What they are and why they matter

Medicare Star Ratings: What they are and why
they matter

Every year, the Centers for Medicare and Medicaid Services (CMS) uses information from member satisfaction surveys, plans, and providers to give overall quality performance star ratings to Medicare Advantage plans.

A plan can get a rating from 1 to 5 stars, with 5 stars being the highest rating. A high rating reflects a plan’s commitment to members to ensure that they receive the best possible care.

Understanding how these ratings work can help you be more confident about which Medicare Advantage plan to choose. Let’s take a closer look at how the Medicare star rating system works and what it means to you.

Categories used to rate Medicare Advantage Plans

  • Helping members stay healthy — How many of the health plan’s members have access to and participate in preventive care.
  • Provider support for members with chronic conditions – How well a member’s doctor helps them manage conditions like diabetes, high blood pressure, or high cholesterol.
  • Member experiences with their plan and providers – How easy it is for members to use their plan, understand their benefits, and communicate with their doctor.
  • Providing effective customer service – How well customer service representatives respond to member questions and appeals.

Why star ratings matter

Star ratings give you a quick and easy way to compare plans based on quality and performance, in addition to considerations like premiums, benefits, and network. In other words, these ratings can help you choose a Medicare plan that’s best for your health care needs and budget.

How to enroll in a Highmark 5-star rated Medicare Advantage plan

If you’re new to Medicare, you can enroll in a 5-star plan during your Initial Enrollment Period (IEP). If you’re already enrolled in a Medicare plan, you qualify for a 5-star Special Enrollment Period (SEP). This SEP is gives you the opportunity to switch to a 5-star Medicare Advantage  plan any time between December 8 and November 30.

Some important guidelines to take into consideration:

  • You can only enroll in a 5-star plan if one is available in your area.
  • If you’re a current Medicare member, you can only switch one time per year. After you switch, your next opportunity to make a change is during the Medicare Annual Enrollment Period, October 15 to December 7
  • Unless you’re new to Medicare, your current plan must be either Original Medicare or a Medicare Advantage plan.

Talk to Highmark's Medicare experts today.

Whether you’re new to Medicare or just looking to learn more about star ratings, visit highmark.com/reservations/medicare to set up a personal consultation or call 866-682-7969 (TTY users may call 711), 8 a.m. - 8 p.m. seven days a week.

Let Highmark help with finding your Medicare plan

Schedule a personal consultation with a Highmark Medicare advisor or call 866-320-8359 , 7 days a week, 8 a.m. - 8 p.m. (ET), (TTY users call 711)

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Highmark Choice Company, Highmark Senior Health Company, and Highmark Senior Solutions Company are Medicare Advantage plans with a Medicare contract. HM Health Insurance Company is a PDP plan with a Medicare contract. Enrollment in Highmark Choice Company, Highmark Senior Health Company, Highmark Senior Solutions Company, and HM Health Insurance Company depends on contract renewal.

Health benefits or health benefit administration may be provided by or through Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Senior Health  Company, Highmark Senior Solutions Company, or Highmark Health Insurance Company, all of which are independent licensees of the Blue Cross Blue Shield Association.  All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration.

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