February 15, 2017

When it comes to Medicare, not all plans are created equal

The CMS 5-star Special Enrollment Period spotlights the importance of quality health care.

Since 2004, the number of Medicare beneficiaries enrolled in private Medicare individual and group health plans has more than tripled from 5.3 million to 17.6 million in 2016. There are also more Medicare plan choices than ever before — which can be both a boon and a burden to many beneficiaries.

How does one choose a Medicare health plan that best meets individual needs? And how best to evaluate all the many plans on the market?

With the Medicare star quality ratings system, the Centers for Medicare & Medicaid Services offers beneficiaries an objective way to evaluate plans. Every year, plans earning the highest rating of 5 out of 5 stars get a Special Enrollment Period from Dec. 8 through Nov. 30 — allowing beneficiaries an extra opportunity to switch to a 5-star plan once annually.

Medicare 5 Stars - white stars on a blue background

Who is eligible for the Medicare 5-star Special Enrollment Period?

  • Beneficiaries currently enrolled in any Medicare Advantage/Cost plan, Medicare Advantage/Cost plan with prescription drug coverage (Part D) or Medicare Prescription Drug (PDP) plan, including those that already have a 5-star rating
  • Beneficiaries who are enrolled in Original Medicare and meet the eligibility requirements

Finding best-fit care and coverage

Beneficiaries may want to change their Medicare health plan for any number of reasons. For instance, they may not be satisfied with the coverage, cost, doctor choice or convenience of their current plan, or their circumstances or health care needs may have changed.

Under the 5-star Special Enrollment Period, beneficiaries who wish to change their Medicare health plan to a 5-star plan have 45 extra weeks outside of the annual fall Open Enrollment period to reassess their plan, evaluate others and change to a 5-star plan if they wish.

Quality of people, quality of care

Jane Hall, a Medicare Advantage member in Northern California, says that quality is a primary reason her family has chosen Kaiser Permanente. “There’s something very special about Kaiser Permanente,” she said. “The quality of the people who work there is a huge factor in why my husband, parents, two children and I are all members. We have wonderful relationships with our providers, and the quality of care we receive is fantastic.”

“The best doctors integrate the family into a patient’s care,” said Hall who, with her two sisters, serves as caregiver for their parents — both in their eighties and Kaiser Permanente members for more than 40 years. “Kaiser Permanente makes the most of technology,” she said. “It lets our doctors care for us better because they are connected and have good tools. And as a caregiver, having access to so many resources on kp.org is really helpful.”

Shining a light on quality

The CMS 5-star Special Enrollment Period spotlights the importance of quality health care. The star quality ratings are based on care and service quality measures across nine categories, including staying healthy, managing chronic conditions, member satisfaction, customer service and pharmacy services.

In 2017, five out of seven of Kaiser Permanente service areas earned 5 out of 5 stars for quality and service by CMS. Of the 1.6 million beneficiaries enrolled in 5-star plans nationwide, 81 percent are Kaiser Permanente Medicare members.

“The high star ratings we achieve year after year reflect the dedication our physicians and care teams have to the quality care and total health of our members,” said  Patrick Courneya, MD, executive vice president and chief medical officer for Kaiser Foundation Health Plan and Hospitals. “Our members are true partners in their own health care, making decisions with their care team to detect, prevent and treat disease and chronic conditions. This personalized approach to care not only drives best health outcomes, but helps members live their best life and pursue the activities they love.”

“We are proud to be recognized for the high-quality care we provide to Kaiser Permanente Medicare members,” said Michael Kanter, MD, executive vice president and chief quality officer of The Permanente Federation, the national organization for the more than 20,000 physicians who provide care to Kaiser Permanente members and patients. “Permanente Medicine involves exceptional team-based care, using the latest technology, evidence and comprehensive systems while keeping the patient at the center of everything we do.”

Medicare beneficiaries in California, Colorado, Oregon, Washington, Maryland, Virginia and the District of Colombia who wish to change to a Kaiser Permanente 5-star Medicare health plan may do so until Nov. 30. Beneficiaries can learn more about the star ratings and Kaiser Permanente’s Medicare health plans by visiting kp.org/medicarestars.