Wednesday, July 17, 2013


The  Centers  for  Medicare  &  Medicaid  Services  (CMS)  uses  a  five-star  rating  system  to  measure  Medicare beneficiaries’ experience with their health plans and the health care system. This rating system  applies  to  all  Medicare  Advantage  (MA)  lines  of  business:  Health  Maintenance  Organization  (HMO),  Preferred  Provider  Organization  (PPO),  Private  Fee-for-Service  (PFFS)  and  prescription  drug  plans  (PDP). 

The program is a key component in financing health care benefits for MA plan enrollees. In addition, the  ratings  are  posted  on  the  CMS  consumer  website,,  to  give  beneficiaries  help  in  choosing among the MA plans offered in their area.

CMS Goals for the Five-star Rating System
* Implement provisions of the Affordable Care Act
* Clarify program requirements
* Strengthen beneficiary protections
* Strengthen CMS’ ability to distinguish stronger health plans for participation in Medicare Parts C
and D and to remove consistently poor performers

How Are Star Ratings Derived?

A health plan’s rating is based on measures in five categories: 
* Members’ compliance with preventive care and screening  recommendations
* Chronic condition management
* Plan responsiveness, access to care and overall quality 
* Customer service complaints and appeals
* Clarity and accuracy of prescription drug information and pricing

Benefits to Providers
* Improved patient relations
* Improved health plan relations
* Increased awareness of patient safety issues
* Greater focus on preventive medicine and early disease detection
* Strong benefits to support chronic condition management

Benefits to Members
* Improved relations with their doctors
* Greater health plan focus on access to care
* Increased levels of customer service
* Greater focus on preventive services for peace of mind, early detection and health care that matches their individual needs

CarePlus Health Plans, Inc.’s Commitment 
CarePlus is strongly committed to providing high-quality Medicare health plans that meet or exceed all  CMS quality benchmarks. The structure and operations of the CMS star rating system ensures that pay-for-performance funding is used to protect or, in some cases, to increase benefits and to keep member premiums low.

CarePlus  encourages  members  to  become  engaged  in  their   reventive  and  chronic  care  management  through outreach, screening opportunities and Medicare member rewards. 

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