For the first time, the Centers for Medicare and Medicaid Services is requiring the display of five-star ratings for health plans offered on the Affordable Care Act exchanges, beginning with the 2020 open enrollment season.
Along with the quality of the plan, the star ratings will compare prices. Consumers can view both on the exchange websites, including HealthCare.gov.
The star ratings data for the 2020 plan year will be released closer to open enrollment, which starts November 1 and ends on December 15.
CMS has posted star ratings and quality measure level data from the 2019 plan year in a public use file for the public, researchers and others to use and analyze the data.
Exchange health plans are given a rating on a 1 to 5 scale, with 5 stars representing the highest quality. Star ratings are based on measures such as how other enrollees rate the doctors in the plan's network, the care they've received, how well the plan's network providers coordinate with enrollees and other doctors to give members healthcare that achieves the best results and the overall administration of the plan, including customer service and availability of information.
In some cases in which the plans are new or have low enrollment, star ratings may not be available. The lack of a star rating does not mean the plans have a low quality rating, CMS said.
WHY THIS MATTERS
The star ratings in the exchange market makes the insurers offering these plans responsible for the quality of care given by providers to their members.
The ratings also encourage competition, in those areas where consumers have a choice of more than one exchange plan.
The overall star ratings are based on three categories: medical care, member experience and plan administration.
Medical care is based on how well the plans' network providers manage member healthcare, including providing regular screenings, vaccines, and other basic health services.
Member experience is based on surveys of member satisfaction with their healthcare and doctors and ease of getting appointments and services.
Plan administration is based on how well the plan is run, including customer service, access to needed information and network providers ordering appropriate tests and treatment.
THE LARGER TREND
During the 2017 and 2018 open enrollment periods, CMS conducted a limited pilot and displayed star ratings on HealthCare.gov in two states, Virginia and Wisconsin.
The pilot was expanded to include three additional exchange states – Michigan, Montana, and New Hampshire – during the 2019 open enrollment period.
The publication of the ratings system for exchange plans is similar to other CMS star rating programs, such as the Nursing Home Compare and Medicare Advantage.
ON THE RECORD
"Knowledge is power, and for the first time, consumers will have access to meaningful, simple-to-use information to compare the quality, along with the price, of health plans on exchange websites, including HealthCare.gov," Said CMS Administrator Seema Verma.
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