October 19, 2023  – Medicare Advantage and Medicare Part D prescription plan scores seems to be waning, as the CMS’s recent data analysis indicates. There’s been a consecutive slump in their star ratings, a tool designed to reflect the satisfaction of consumers and the caliber of care.

The yardstick for these ratings remains the familiar five-star system. A one-star rating is the least favorable, while a five-star rating signifies optimal performance. Key determinants of this score include consumer contentment and the quality of healthcare services rendered.

For 2024, the grading formula underwent a minor change. New metrics were introduced for Part C concerning care transitions and subsequent care, the diabetes care measure under Part C was omitted, and an “outlier deletion” parameter was established.

Looking at specifics, the mean star rating for 2024’s Medicare Advantage plans, which include drug coverage, dwindled from 4.14 in 2023 to 4.04. In addition, a comparative study of year-on-year data highlights that only 42% of Medicare Advantage with drug coverage contracts secured ratings of four stars and above. This is a drop from the 51% that we saw in 2023. Of note, 74% of the beneficiaries have chosen plans that boast a four-star rating or higher for 2024.

On the Part D prescription plan front, the 2024 average star rating witnessed a reduction to 3.11 from 3.25 in the preceding year. Interestingly, only 2% of Part D beneficiaries are linked with plans that achieved a rating of four stars or more.

The silver lining of the data is that 36 contracts clinched the much-sought-after five-star rating, thus being labeled as high-performing on the Medicare Plan Finder. From these, 31 were Medicare Advantage with drug coverage contracts, three aligned with the 1876 Cost Contracts, and the remaining two were Part D plans. Eleven of these plans didn’t achieve this coveted tag the previous year, which is encouraging to see some progress being made.

On the flip side, six contracts were relegated to the low-performance category, signifying that these plans haven’t crossed the three-star threshold for three consecutive years. This is a significant jump from just a single contract in 2023.

Another notable takeaway from the data is that non-profit organizations consistently outshine their for-profit counterparts. 56% of non-profit Medicare Advantage plans received four or more stars, while only 36% of for-profit plans achieved this feat. For Part D plans, the divide was even more pronounced, with 50% of non-profit plans reaching the four-star mark compared to a mere 14% of for-profit plans.

It’s also evident that seasoned players in the Medicare Advantage domain tend to fare better. Those boasting a decade or more of service in the program had a higher likelihood of attaining four or more stars compared to their younger counterparts with less than five years under their belt.

Given that the Medicare open enrollment window remains open until December 7, 2023, consumers have an opportunity to leverage these star ratings and make informed decisions on their plan selections for the upcoming year.