9 out of 10 Medicare Benefit members are enrolled in plans that earned the federal government’s highest high quality marks for 2022, in response to new federal knowledge.
Between the strains: Well being insurers had been fast to tout the standard scores in press releases. However the federal authorities went simple on the grades in the course of the pandemic, and consultants have lengthy thought-about MA’s high quality system to be “flawed and inconsistent.”
Driving the information: Medicare releases MA star scores yearly forward of this system’s open enrollment window, which begins Oct. 15 and runs till Dec. 7, as a manner to assist seniors store for plans (versus enrolling in conventional Medicare).
- Utilizing a five-star system, Medicare grades MA plans on issues like their customer support, members’ entry to medication and companies, and the way nicely they assist folks get well being screenings.
- Insurers that attain a minimum of 4 stars get extra bonus funds from the federal authorities. These bonuses have nearly quadrupled from $3 billion in 2015 to $11.6 billion in 2021, in response to the Kaiser Household Basis.
The massive image: It was much more troublesome to be graded as a “high-quality” plan a decade in the past.
- In 2013, simply 38% of MA enrollees had been in plans with 4 or extra stars.
- A big chunk of that change will be attributed to insurance coverage firms working the system.
- Over the previous a number of years, large insurers have merged lower-rated plans into higher-rated ones to get the bonus cash, and with no discernible enchancment in high quality, the Wall Avenue Journal reported in 2018.
The underside line: Simply because a Medicare Benefit plan will get a minimum of 4 stars does not imply high quality is assured.
Go deeper: Medicare Benefit continues progress regardless of longstanding issues