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How does Medicare Star Quality Ratings* work?
Each Medicare health plan earns an overall rating from 5 Stars to 1 Star. The ratings are updated annually based on ongoing monitoring and analysis.
★★★★★ Excellent performance
★★★★ Above average performance
★★★ Average performance
★★ Below average performance
★ Poor performance
Who created Medicare Star Quality Ratings?
The rating system is developed by the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers Medicare. It provides Medicare beneficiaries with a way to assess Medicare Advantage (MA) health plans based on quality of care and service delivery.
The system is based on measures spanning these 5 categories:
- Outcomes measures that focus on improvements to a beneficiary's health from the care provided
- Intermediate outcomes measures that contribute to the outcome measures above
- Patient experience measures represent beneficiaries' perspectives about the care they’ve received
- Access measures reflect issues that may create barriers to receiving care
- Process measures that capture the ways health care is provided
What do Medicare Star Quality Ratings assess?
Medicare health plan performance is measured based on major categories that include:
- Preventive care
- Chronic care
- Prescription drug services
- Customer service
- Member satisfaction
*Every year, Medicare evaluates plans based on a 5-star rating system.
In California, Hawaii, and Washington, Kaiser Permanente is an HMO plan with a Medicare contract. In Colorado, Kaiser Permanente is an HMO, HMO-POS and PPO plan with Medicare contracts. In Oregon, Southwest Washington, Georgia, Maryland, Virginia and the District of Columbia, Kaiser Permanente is an HMO and HMO-POS plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal.
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This page was last updated: October 10, 2024 at 12:00 a.m. PT