Medicare Advantage - What Is Being Measured?

What Is Being Measured?

The Medicare Advantage Plan Star Ratings system rates Medicare Advantage (MA) plans on a scale of 1 - 5 stars. There are different domains for MA plans versus Prescription Drug Plans (PDPs).

For plans covering health services, the overall score for quality of those services covers 36 different topics in 5 categories:

• Staying healthy: screenings, tests, and vaccines: Includes how often members got various screening tests, vaccines, and other check-ups that help them stay healthy.
• Managing chronic (long-term) conditions: Includes how often members with different conditions got certain tests and treatments that help them manage their condition.
• Ratings of health plan responsiveness and care: Includes ratings of member satisfaction with the plan.
• Health plan member complaints and appeal: Includes how often members filed a complaint against the plan.
• Health plan telephone customer service: Includes how well the plan handles calls from members.

For plans covering drug services, the overall score for quality of those services covers 17 different topics in 4 categories:

• Drug plan customer service: Includes how well the drug plan handles calls and makes decisions about member appeals.
• Drug plan member complaints and Medicare audit findings: Includes how often members filed a complaint about the drug plan and findings from Medicare’s audit of the plan.
• Member experience with drug plan: Includes member satisfaction information.
• Drug pricing and patient safety: Includes how well the drug plan prices prescriptions and provides updated information on the Medicare website. Includes information on how often members with certain medical conditions get prescription drugs that are considered safer and clinically recommended for their condition.

For plans covering both health & drug services, the overall score for quality of those services covers all of the 53 topics listed above.