Medicare Advantage (MA) programs are a popular choice for many beneficiaries seeking comprehensive health coverage. Understanding how to Compare Medicare Advantage Programs is crucial for making informed decisions. A key tool in this comparison is the Medicare Star Ratings system, which evaluates plans based on quality and performance. This analysis delves into the 2024 Star Ratings for Medicare Advantage and Part D plans, examining key trends and distributions to help you better compare Medicare Advantage programs.
Overall Star Rating Distribution: For-Profit vs. Non-Profit MA-PDs
The Centers for Medicare & Medicaid Services (CMS) Star Ratings provide an annual assessment of Medicare plans, ranging from 1 to 5 stars, with 5 stars representing the highest quality. Examining the distribution of these ratings reveals differences between for-profit and non-profit MA-PD (Medicare Advantage and Prescription Drug) plans.
Table 3 from the original data showcases the 2024 Overall Star Ratings for both for-profit and non-profit MA-PDs.
For-profit plans constitute a larger number of rated contracts (340) compared to non-profit plans (155). However, a closer look at the higher star ratings (4 stars and above) reveals a nuanced picture. While for-profit plans have a greater count of 5-star contracts (25 vs. 6), non-profit plans demonstrate a stronger concentration in the 4 and 4.5-star categories. Specifically, a significantly higher percentage of non-profit plans achieve 4.5 stars (25.81% vs 8.97%) and 4 stars (26.45% vs 21.03%). When weighted by enrollment, the disparity becomes even more pronounced, suggesting that a larger proportion of beneficiaries in non-profit plans are enrolled in higher-rated plans.
Part D Ratings: Comparing For-Profit and Non-Profit PDPs
Similarly, Part D ratings, which specifically evaluate the prescription drug coverage aspect of Medicare plans, also exhibit differences between for-profit and non-profit PDPs (Prescription Drug Plans). Table 4 details the 2024 Part D ratings distribution.
In the realm of Part D ratings, non-profit PDPs significantly outperform for-profit counterparts at the top tier. Notably, all 5-star and 4.5-star Part D plans are non-profit. For-profit PDPs are more heavily concentrated in the 3 and 3.5-star categories. This stark contrast highlights a potential trend where non-profit PDPs may prioritize quality and member satisfaction in their drug coverage offerings more effectively than for-profit PDPs. However, it’s important to note the smaller sample size of non-profit PDPs (18) compared to for-profit PDPs (29) in this analysis.
The Impact of Program Longevity on Star Ratings
Experience within the Medicare program appears to be a significant factor influencing Star Ratings. Plans with longer tenure tend to achieve higher ratings, indicating a learning curve and continuous improvement in performance over time.
Table 5 examines the distribution of Overall Star Ratings for MA-PDs based on their years in the program.
MA-PD contracts with 10 or more years in the program are significantly more likely to attain 4 stars or higher compared to newer contracts (less than 5 years). Specifically, 8.15% of long-term contracts achieve 5 stars, and a substantial 26.67% reach 4 stars. In contrast, for contracts with less than 5 years, these percentages are considerably lower (3.53% and 14.12% respectively). This suggests that established plans benefit from accumulated experience, refined processes, and potentially stronger provider networks, leading to better performance in quality measures.
Table 6 further reinforces this trend by analyzing Part D ratings in relation to program length for PDPs.
Similar to MA-PDs, PDPs with 10 or more years of experience demonstrate a higher likelihood of achieving top Star Ratings. While the sample size for PDPs with less than 10 years of experience is small, the data indicates that longer-tenured PDPs dominate the higher rating categories. This consistency across both MA-PD and PDP plans underscores the importance of program experience in achieving and maintaining high Star Ratings.
Average Star Ratings Across Measures: 2021-2024 Trends
Analyzing average Star Ratings across various Part C and D measures over the past four years provides insights into performance trends and areas of improvement or decline. Tables 7, 8, and 9 present these averages.
Table 7 displays the 2021-2024 average Star Ratings for Part C measures.
Several Part C measures have seen a decrease in average Star Ratings from 2021 to 2024. Notably, “Care for Older Adults – Medication Review,” “Care for Older Adults – Pain Assessment,” “Diabetes Care – Blood Sugar Controlled,” and “Complaints about the Plan” have all experienced significant declines. Conversely, some measures like “Customer Service” and “Care Coordination” have shown slight improvements or remained stable. These fluctuations may reflect changes in healthcare delivery, measurement methodologies, or plan focus areas.
Table 8 focuses on the 2021-2024 average Star Ratings for Part D measures within MA-PDs.
Similar to Part C measures, several Part D measures within MA-PDs have also witnessed a decline in average Star Ratings. “Call Center – Foreign Language Interpreter and TTY Availability,” “Complaints about the Plan,” and “MPF Price Accuracy” show notable decreases. “Drug Plan Quality Improvement” is another measure that has seen a significant drop, particularly between 2022 and 2023, although it shows a slight recovery in 2024.
Table 9 presents the 2021-2024 average Star Ratings for Part D measures specifically for PDPs.
PDP-specific Part D measures also reflect a downward trend in average Star Ratings for several metrics, mirroring the patterns observed in MA-PD Part D measures. “Call Center – Foreign Language Interpreter and TTY Availability,” “Complaints about the Plan,” and “Drug Plan Quality Improvement” exhibit similar declines. These consistent decreases across various measures and plan types warrant further investigation into the underlying factors contributing to these trends.
High and Low Performing Contracts: Identifying Leaders and Areas for Improvement
To further facilitate the comparison of Medicare Advantage programs, CMS also designates high and low-performing contracts. High Performing Icons are awarded to plans achieving consistently high Star Ratings, while Low Performing Icons indicate contracts needing significant improvement.
Table A1 lists MA-PD contracts receiving the 2024 High Performing Icon.
Table A2 identifies 1876 Cost Contracts with the High Performing Icon.
Table A3 details PDP contracts receiving the High Performing Icon.
These tables provide a roster of top-tier plans that have demonstrated exceptional performance across various quality measures. Beneficiaries seeking high-quality Medicare coverage can use this list as a starting point when comparing Medicare Advantage programs.
Conversely, Table A4 lists contracts receiving the Low Performing Icon for the 2024 Star Ratings.
Contracts on this list have been flagged for significant performance issues and may warrant closer scrutiny. While these plans are still available, beneficiaries should carefully consider the reasons for the low-performance designation and weigh them against their healthcare needs.
Conclusion
Comparing Medicare Advantage programs effectively requires a comprehensive understanding of quality metrics like Star Ratings. This analysis of the 2024 Star Ratings data reveals several key insights. Non-profit plans generally exhibit stronger performance in higher Star Rating categories, particularly for Part D. Program experience is a significant predictor of higher ratings, suggesting continuous improvement over time. Average Star Ratings across many measures have shown a declining trend from 2021 to 2024, indicating potential areas needing attention within the Medicare program. By utilizing resources like the High and Low Performing Contract lists and carefully evaluating Star Ratings across different measures, beneficiaries can make more informed choices when selecting a Medicare Advantage program that best meets their individual needs.
