Rating Medicare Advantage plans
Most people know that Medicare is a federal health insurance program that covers people 65 and older, and others who meet certain criteria. What many people don’t know is that the quality of plans varies from one insurance company to another. In an effort to track the quality and effectiveness of Medicare Advantage plans around the country, the Centers for Medicare and Medicaid Services (CMS—the federal agency that oversees Medicare) examines and rates them. CMS uses a 5-star rating system that consumers can use as one method to judge their available choices.
CMS rates plans on a scale of one to five stars. Here is the description of each level:
Five Stars—Excellent performance
Four Stars—Above average performance
Three Stars—Average performance
Two Stars—Below average performance
One Star—Poor performance
Measures that make the ratings
CMS reaches its star ratings for health plans by assessing 53 standard performance measures based on administrative data and surveys of Medicare beneficiaries. CMS considers a number of aspects of health plan services for members—including the quality of care from their doctors and other health care providers, satisfaction with their plan’s efforts to keep them healthy, the quality and responsiveness of customer service and their plan’s appeal processes. Specific quality measures range from whether members get needed care, to how the health plan helps members manage chronic conditions, to how many complaints the plan receives.
A separate score for Part D prescription drug plans is combined with health plan ratings to take into account such factors as customer service, member satisfaction, drug pricing and patient safety.
Only 25 percent of Medicare Advantage members nationwide were covered by a plan with four or more stars in 2010. Today, members of Security Health Plan’s Advocare plan enjoy the benefits of a 5-star rating from CMS. In fact, Security Health Plan was one of only three plans in the nation to receive this recognition in 2011, one of only nine to receive a 5-star rating in 2012, and one of only two to receive the highest rating for both years.
A high CMS rating is not just window dressing for a health insurance company. It reflects the efforts the company makes to help its members remain healthier by better managing chronic illnesses, staying as active as possible and keeping up with preventive measures such as annual physical exams and flu shots. The 5-star rating for Security Health Plan truly reflects extraordinary effort from both the professionals inside the organization and the many members they serve.
Next steps
At Security Health Plan, we know that you have questions when it comes to your Medicare Plan decisions. We want you to know that we’re here as a knowledgeable resource when it comes to making those important decisions.
- To learn more, check here for a schedule of informational seminars.
- To enroll in one of Security Health Plan’s Medicare Advantage options online, you can apply using our fast, easy application.
- To receive an application you can begin filling out at home, call 1-877-998-0998 or 1-715-221-9897 (TTY: 1-877-727-2232) from 8 a.m. to 8 p.m., seven days a week.
- Contact your Security Health Plan agent.
- E-mail us at shpcsweb@marshfieldclinic.org to request to have an application mailed to you.
- Stop by any of our offices. Print and mail our enrollment application. If you need an alternative format or translation, please contact Security Health Plan.
- Mail your completed application to:
Security Health Plan
1515 N. Saint Joseph Avenue
P.O. Box 8000
Marshfield, WI 54449-8000
To find out more about Medicare, the government offers a helpful, informative guide, Medicare & You, for free on its Web site. The guide can help answer the most frequently asked questions about Medicare. We also recommend that you seek out friends and family members for advice, or ask the county benefits specialist at your local Department of Aging.
Security Health Plan of Wisconsin, Inc., is an HMO plan with a Medicare contract. For more information, contact the plan. R146