Medicare Star Ratings – What Plan Sponsors Need to Know By Theresa C. Carnegie and Roy M. Albert

Originally published in BNA’s Medicare Report, 11/30/2012.

On Oct. 12, the Centers for Medicare & Medicaid Services published its 2013 Medicare Health Plan Quality and Performance Ratings, also called ‘‘Star Ratings’’ or ‘‘Plan Ratings.’’ Star Ratings assist enrollees in choosing Medicare Advantage (‘‘MA’’) plans and Prescription Drug Plans (‘‘PDPs’’) during the annual enrollment period beginning in October and ending in December.

In the past, Star Ratings were used both as an informational tool for beneficiaries and as a way for CMS to help identify poor performing MA plans and PDPs. These ratings have become increasingly important since the enactment of the Patient Protection and Affordable Care Act of 2010, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively, the ‘‘Affordable Care Act’’). The Affordable Care Act requires that MA quality bonus payments be tied to Star Ratings—a requirement that has generated a fair amount of controversy.

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