CMS Star Rating

The Centers for Medicare & Medicaid Services (CMS) uses a five-star quality rating system to measure Medicare beneficiaries’ experience with their health plans and the health care system. This rating system applies to Medicare Advantage plans that cover both health services and prescription drugs (MA-PD). The ratings are posted on the CMS consumer website, www.medicare.gov (By clicking on this link you will be leaving the Wellcare By Health Net website.) to give beneficiaries help in choosing an MA and MA-PD plan offered in their area. 5 Stars is the highest rating a health plan can receive with 1 Star being the lowest. The Star Rating program is designed to promote improvement in quality and recognize primary care providers for demonstrating an increase in performance measures over a defined period of time.

The Overall Star Rating gives an overall rating of the plan’s quality and performance for the types of services each plan offers. For plans covering health services, this is an overall rating for the quality of many medical/health care services that fall into 5 categories:

• Staying healthy: screening tests and vaccines. Includes whether members got various screening tests, vaccines, and other check-ups to help them stay healthy.
• Managing chronic (long-term) conditions: Includes how often members with certain conditions got recommended tests and treatments to help manage their condition.
• Member experience with their health care Providers and their Health Plan: Includes member ratings of the member experience with various aspects of treatment, care and services provided by the Health Plan and Providers.
• Member complaints and changes in the health plan’s performance: Includes how often Medicare found problems with the plan and how often members had problems with the plan. Includes how much the plan’s performance has improved (if at all) over time.
• Health plan customer service: It shows how quickly and how well the plan handles calls and questions made by members.

For plans covering drug services, this is an overall rating for the quality of prescription-related services that fall into 4 categories:

• Drug plan customer service: It shows how quickly and how well the plan handles calls and questions made by members.
• Member complaints and changes in the drug plan’s performance: Includes how often Medicare found problems with the plan and how often members had problems with the plan. Includes how much the plan’s performance has improved (if at all) over time.
• Member experience with plan’s drug services: Includes items such as member ratings about the ease of getting prescriptions filled and members' overall rating of the drug plan.  
• Drug safety and accuracy of drug pricing: Includes how accurate the plan’s pricing information is and how often members with certain medical conditions are prescribed drugs in a way that is safer and clinically recommended for their condition.

Every year, Medicare evaluates plans based on a 5-star rating system.

CMS Star Rating

The Centers for Medicare & Medicaid Services (CMS) uses a five-star quality rating system to measure Medicare beneficiaries’ experience with their health plans and the health care system. This rating system applies to Medicare Advantage plans that cover both health services and prescription drugs (MA-PD). The ratings are posted on the CMS consumer website, www.medicare.gov (By clicking on this link you will be leaving the Wellcare By Health Net website.) to give beneficiaries help in choosing an MA and MA-PD plan offered in their area. 5 Stars is the highest rating a health plan can receive with 1 Star being the lowest. The Star Rating program is designed to promote improvement in quality and recognize primary care providers for demonstrating an increase in performance measures over a defined period of time.

The Overall Star Rating gives an overall rating of the plan’s quality and performance for the types of services each plan offers. For plans covering health services, this is an overall rating for the quality of many medical/health care services that fall into 5 categories:

• Staying healthy: screening tests and vaccines. Includes whether members got various screening tests, vaccines, and other check-ups to help them stay healthy.
• Managing chronic (long-term) conditions: Includes how often members with certain conditions got recommended tests and treatments to help manage their condition.
• Member experience with their health care Providers and their Health Plan: Includes member ratings of the member experience with various aspects of treatment, care and services provided by the Health Plan and Providers.
• Member complaints and changes in the health plan’s performance: Includes how often Medicare found problems with the plan and how often members had problems with the plan. Includes how much the plan’s performance has improved (if at all) over time.
• Health plan customer service: It shows how quickly and how well the plan handles calls and questions made by members.

For plans covering drug services, this is an overall rating for the quality of prescription-related services that fall into 4 categories:

• Drug plan customer service: It shows how quickly and how well the plan handles calls and questions made by members.
• Member complaints and changes in the drug plan’s performance: Includes how often Medicare found problems with the plan and how often members had problems with the plan. Includes how much the plan’s performance has improved (if at all) over time.
• Member experience with plan’s drug services: Includes items such as member ratings about the ease of getting prescriptions filled and members' overall rating of the drug plan.  
• Drug safety and accuracy of drug pricing: Includes how accurate the plan’s pricing information is and how often members with certain medical conditions are prescribed drugs in a way that is safer and clinically recommended for their condition.

Every year, Medicare evaluates plans based on a 5-star rating system.