Roughly 51 percent of Medicare Advantage (MA) plans that offer prescription drug coverage will have an overall rating of four stars or higher in 2023.
The Centers for Medicare & Medicaid Services (CMS) last week released the 2023 MA and Medicare Part D Star ratings and, as expected, a significant number of plans that earned four or more stars in 2022 were unable to maintain them for 2023.
Indeed, the number of MA plans with prescription drug coverage (MA-PD) with four or more stars have dropped from last year’s record high of 68 percent to 51 percent this year.
Industry experts predicted it would be a challenge for plans to maintain last year’s high ratings in a post-pandemic landscape. Last year CMS relaxed its standards for measuring plans due to the COVID-19 public health emergency (PHE). Under the CMS “extreme and uncontrollable circumstances policy,” MA plans could choose the better of the 2021 or 2022 ratings for most measures. The adjustment resulted in a higher-than-normal distribution of 2022 Star ratings.
RELATED: RISE Radio Episode 10: Liz Haynes & Melissa Smith on 2022 Medicare Star ratings and what plans must do to maintain those scores
For 2023, the only adjustment CMS have made for the impact of the PHE are the measure-level adjustments for three Healthcare Effectiveness Data and Information Set (HEDIS) measures derived from the 2021 Health Outcomes Survey (HOS). CMS also introduced guardrails in the 2023 Star ratings for all measures that have been in the Part C and D Star rating program for more than three years except the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and the Part C and Part D improvement measures. The guardrails are bi-directional caps that restrict upward and downward movement of a measure’s cut points for the current year’s measure-level Star ratings compared to the prior year’s measure-threshold specific cut points.
In addition, MA plans also saw the weight of member experience and access measures increase from two to four for the 2023 Star ratings.
As a result of the changes, CMS announced
- Approximately 51 percent of MA-PDs (260 contracts) in 2023 earned four stars or higher for their 2023 overall rating
- Weighted by enrollment, roughly 72 percent of MA-PD enrollees are currently in contracts that will have four or more stars in 2023
- Approximately 31 percent of stand-alone Part D plans (16 contracts) in 2023 received four or more stars for their 2023 Part D rating
- Weighted by enrollment, about nine percent of enrollees in these stand-alone plans are in contracts with four or more stars
- Sixty-two plans will have five stars in 2023, including 57 MA-PD plans and two stand-alone plans
- Ninety MA-PD plans will have an overall rating of three stars in 2023 compared to 25 plans that had the designation in 2022
- Thirty-seven plans will have an overall rating of two stars in 2023 compared to only two plans that had the designation in 2022
- One plan received a low-performing score for 2023 for consistently low-quality ratings (last year no contracts received this warning)
The Star Ratings system is meant to help Medicare consumers compare the quality of available MA health and drug plans. MA plans that earn at least four stars receive five percent quality bonuses, which they are to use to offer additional benefits to enrollees, reduce cost sharing, or provide innovations in care.
To better understand the impact of 2023 Star ratings, join RISE and Cotiviti for a webinar, Star Rating Reflections, at 1:30 p.m. EST, Thursday, Oct 27. In addition, RISE’s 13th annual Star Ratings Master Class conference will take place December 13-15 at the Intercontinental San Diego.