Medicare 5-Star Rating System is Changing

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Medicare 5-Star Rating System, how has it changed?

The efforts to improve health services for people utilizing Medicare prompted a rating system that consists of 2-5 stars, starting in 2008.  Medicare plans subjected to this rating system are Medicare Part C & D; these plans are known as Medicare Advantage.  The rating system is to ensure patients are informed when selecting a Medicare Advantage Plan.

Chalkboard with the word Medicare displayed in the middle.

Recent changes to the Medicare Advantage System have placed a higher rating on Patient Outcomes and Patient Experiences.   The time frame for determining the rating has also been expanded from three quarters to four quarters.  Another change is to on the scoring of Activities of Daily Living measure from a state based system to a national based system.

The primary changes to the Star Rating include the following areas:

  • Outcomes
  • Intermediate Outcomes
  • Patient Experience
  • Access
  • Process

Outcomes and Intermediate Outcomes have the highest weight, 3 times more than process, in the matrix, with patient experience and access carrying 1.5 times more weight than process.  The focus is on delivering a quality healthcare system with lasting outcomes, quality service and accessibility for the client.

Patients who are blind or have low vision need to be provided with equal access to their plan of care information, medical choices, the medical process and other related information.  This is something that patients need to consider when filling out Health Care Surveys.

Health Care Surveys (both standard and complaints), Quality Measures and Staffing are still primary components to the Medicare Advantage Part C and D rating system along with the 5-new additions.  Let your voices be heard and advocate for your medical information in a format that allows you independence in managing your own care.

In October 2016 the Center for Medicaid and Medicare Services (CMS) released this Five Start Report to assist Medicare users in locating the appropriate Medicare Advantage Plan.

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This post was written by Braille Works

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