What are Star Ratings, and How do They Impact Plans

Medicare star ratings are basically a plan’s overall performance and quality based on data that is provided from the prior year. The scale is numbers 5 to 1, with 5 being excellent and 1 being poor. The 5 categories that the Centers for Medicare and Medicaid Services (CMS) uses to review plan performances are:

1. Customer Service
2. Plan Responsiveness
3. Management of Member Complaints
4. Preventative Service (Health outcomes of members)
5. Chronic Condition Management

These ratings impact both the plan sponsor offering them and the clients choosing/staying with them. Plan sponsors benefit from having highly-rated plans by receiving higher rebates and quality bonus payments. This allows them to offer additional supplemental benefits (extras like dental, vision, and hearing), lower to no premiums, and help with future improvements to plan quality. Plans with low stars run the risk of having the contract terminated altogether.

For clients, having a 5-star plan gives them two things. The first is peace of mind. The higher the star rating for a plan, the more confidence they have when choosing that plan. The second is potential special enrollment opportunities. A 5-star Medicare Advantage plan receives a special enrollment period that lasts from December 8^th to November 30^th every year. This allows the client to make a one-time switch to that plan if it’s available in their service area.

Where does Pinnacle Financial Services come in?

Pinnacle Financial Services is the only “FMO” in the country that has access to a special Institutional-equivalent, 5-star plan available in 30 states across the country. This is an exciting opportunity to market a product that the external distribution channel has never sold. Not to mention, we offer the best technology in the business, back-office support, and training. Don’t hesitate to call us today about how to get set up for this unique opportunity!

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