21 Medicare Advantage plans earn 5 stars in CMS release of star ratings

CMS has released the Medicare Advantage and Part D star ratings as Medicare open enrollment begins on October 15.

The Centers for Medicare and Medicaid Services has released the Medicare Advantage and Part D star ratings for 2021.

The 21 health plans earning 5 stars include KelseyCare Advantage, Kaiser Permanente, UnitedHealthcare, CarePlus by Humana, Tufts Health Plan, Health Partners, Capital District Physicians' Health Plan, Quartz Medicare Advantage of Wisconsin, Cigna, Health Sun - Anthem, BCBS - Health Now New York and Martins Point.

The lowest rated plans had 2.5 stars and there were only four: Bright Health, AgeWell New York, Prominence Health Plan and Virginia Premier.

Prominence HealthFirst of Texas is the only contract getting a low performance warning for consistently low quality ratings of 2.5 or fewer stars from at least 2018 through 2021.

None of the plans were rated 2 stars. The majority were rated at 3.5 and 4 stars, 141 and 110 plans respectively. Another 63 were rated 4.5 stars and 61 at 3 stars.

An estimated 417 plans were rated not applicable, not enough data available or plan too new to be rated.

WHY THIS MATTERS

The star ratings are important to both insurers selling private Medicare Advantage plans and to beneficiaries who are looking for Medicare coverage.

Star ratings reflect a plan's performance and are related to quality bonus payments. CMS rates Medicare Advantage health and drug plans on a rating of 1 to 5 stars, with 1 representing poor performance and 5 stars representing excellent performance.

Medicare Advantage with prescription drug coverage contracts are rated on up to 44 unique quality and performance measures; MA-only contracts (without prescription drug coverage) are rated on up to 32 measures; and stand-alone PDP contracts are rated on up to 14 measures. 

There are no new measures introduced for 2021 star ratings. CMS increased the weight of patient experience/complaints and access measures from 1.5 to 2, reflecting the agency's commitment to put patients first, including their assessments of the care received by plans, CMS said.

CMS has been monitoring the impact of the 2019 Novel Coronavirus public health emergency on star ratings and adopted some changes to address the impact. On March 31, CMs adopted changes to the 2021 star ratings to accommodate disruption to data collection posed by the public health emergency as well as changes to the 2022 star ratings to account for expected changes in plan performance. 

The issues facing the healthcare system, including significant differences across regions and demographic groups, create unique challenges for the 2021 and 2022 star ratings calculations, CMS said. Due to these concerns, CMS eliminated the requirement to submit Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data for the 2021 star ratings and used the data from the prior year.

For consumers, the quality ratings of Medicare Advantage and Medicare Part D drug plans remain strong, according to CMS. 

Most Medicare beneficiaries – about 77% – who enroll in Medicare Advantage plans with drug coverage will be in plans with four or more stars in 2021. That compares with 69% of beneficiaries enrolled in such plans in 2017, CMS said.

However, while there is one more 5 star plan for 2021 compared to 2020, there are fewer total plans in 2021 that rate four stars or higher compared to 2020, 195 to 210, respectively. There's also more 3 star plans, 61 for 2021 compared to 55 in 2020. The number of 2.5 star plans is the same at 4 and in 2020, there was one 1 star plan. 

Almost half – about 49% – of Medicare Advantage plans that offer prescription drug coverage will have an overall rating of four stars or higher, up from about 45% in 2017. 

The average star rating for all Medicare Advantage plans with prescription drug coverage improved to 4.06 out of 5 stars in 2021 from 4.02 in 2017. 

THE LARGER TREND

The annual Medicare open enrollment begins on October 15.

CMS has been promoting private Medicare Advantage plans. In late September, the agency said premiums for MA plans are expected to decline 34.2% from 2017 while plan choice, benefits, and enrollment continue to increase.

More than a third of seniors now choose a Medicare Advantage plan over traditional Medicare.

The Medicare Advantage average monthly premium will be the lowest in 14 years (since 2007) for the more than 26 million Medicare beneficiaries projected to enroll in Medicare Advantage plans for 2021, CMS reiterated with the release of the star ratings. 

Based on current enrollment, about 98% of beneficiaries enrolled in stand-alone prescription drug plans for 2021 will be in plans with 3.5 stars or higher, an increase from about 70% in 2020. 

The average star rating for a stand-alone prescription drug plan rose to 3.58 in 2021 from 3.50 in 2020.

CMS publishes the Medicare Advantage and Part D Star Ratings every year to measure the quality of, and reflect the experiences of beneficiaries in, Medicare Advantage and Part D plans. 

ON THE RECORD

"The historically low premiums for Medicare Advantage plans this year would mean little if they didn't come paired with high-quality care," said CMS Administrator Seema Verma. "Thankfully, President Trump's patient-oriented policies have led to exactly that. With nearly half of Medicare Advantage plans with drug coverage rated at four stars or higher, and more than three-quarters of beneficiaries in Medicare Advantage plans with drug coverage enrolled in such four-star plans, seniors are coming out on top in 2021."

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com