Medicare’s five-star quality ratings - Ahwatukee Foothills News: Valley And State

Medicare’s five-star quality ratings

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Posted: Thursday, September 25, 2014 1:00 pm | Updated: 1:17 pm, Fri Sep 26, 2014.

The Centers for Medicare and Medicaid Services (CMS) rates the relative quality of the private plans that are offered to Medicare beneficiaries through the Medicare Advantage program. CMS rates Medicare Advantage plans on a one- to five-star scale, the highest quality being five stars. This star rating provides an overall measure of the plan’s quality and is an indication of the quality of care, access to care, responsiveness, and beneficiary satisfaction provided by the Medicare Advantage plan. This means that the higher the star rating a plan receives, the more likely you are to receive the care you need, when and where you need it - and most of all, you are more likely to be satisfied with your plan.

For each years’ star rating, CMS rates Medicare Advantage health plans based on 53 quality measures and 2 improvement measures. The information that is evaluated for the star rating comes from a comprehensive list of sources:

◦ Customer surveys done by Medicare (you)

◦ Information from clinicians (your doctors)

◦ Information submitted by the Medicare Advantage plans

◦ Results from Medicare's regular monitoring activities and

◦ Reviews of billing and other information that plans submit to Medicare

The overall score for quality of health services covers five categories:

◦ Staying healthy (health screenings, tests, and vaccines)

◦ Managing chronic (long-term) conditions

◦ Ratings of health plan responsiveness and care

◦ Health plan customer complaints and appeals

◦ Health plan telephone customer service

Plans that cover a prescription drug benefit are also rated on the following four categories:

◦ Drug plan customer service

◦ Drug plan customer complaints and Medicare audit findings

◦ Customer experience with drug plan

◦ Drug pricing and patient safety

Improving health care quality is a major focus for CMS. Health plans and providers working together is key to a high star rating for Medicare Advantage plans. Cigna Medicare Advantage HMO plans are designed to keep our customers healthier at lower out-of-pocket costs. We work with our large network of primary care doctors to give them the tools necessary to give our customers the highest quality of care. For 2014, Cigna received 4.5 stars *.

Education is an important part of choosing the right Medicare Advantage plan. Cigna’s Medicare experts can be reached at 1-855-298-4385 (TTY 711) to help answer your questions and discuss plan options available to you. Representatives are available 7 days a week, 8 am – 8 pm.

* Cigna HealthCare of Arizona (CHC-AZ) offers one of the highest-rated Medicare Advantage plan in Arizona, with a 4.5 out of 5 stars for 2014 by www.medicare.gov. Medicare evaluates plans based on a 5-star rating system. Star Ratings are evaluated each year and may change from one year to the next. Cigna Medicare Select Plus Rx (HMO) plans are offered by CHC-AZ under a contract with Medicare. Enrollment in Cigna Medicare Select Plus Rx depends on contract renewal.

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