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HEALTH Insurance
HEALTH INSURANCE INSIGHTS

The Centers for Medicare and Medicaid Services’ Star Ratings help beneficiaries gauge a plan’s quality and performance using 45 metrics.

People who qualify for Medicare, the government insurance program that covers more than 44 million seniors, have two coverage options.

You can choose between:

  • Original Medicare, which is offered by the federal government and includes hospital and medical insurance.
  • Medicare Advantage, which is provided through a private insurer and includes both hospital and medical insurance, as well as likely offering prescription drug and supplemental benefits.

Original Medicare has been around since 1965 and includes Parts A and B. It doesn’t have prescription drug benefits, but you can get a separate Part D prescription drug plan.

Medicare Advantage, also called Part C, hasn’t been around nearly as long. About one-third of Medicare beneficiaries have a and that’s expected to rise in the coming years as more private insurers offer plans.

The most common type of Medicare Advantage plans are health maintenance organization (HMO) plans, though insurers also offer other types of plans like preferred provider organization (PPO) plans.

Most Americans have more than a dozen Medicare Advantage plan choices. To help people compare plans, the Centers for Medicare and Medicaid Services (CMS) issues star ratings each year to measure each plan’s quality. The top plans get five stars.

When looking for a Medicare Advantage plan, a good idea to start is looking at five-star plans. Here's what you need to know about five-star Medicare Advantage plans, a breakdown of the top plans and key things to consider before choosing one.

KEY TAKEAWAYS
  • Seventy-five Medicare Advantage plans with prescription drug benefits received a five-star rating in 2022. That’s an increase from 28 five-star plans in 2021.
  • About 90% of Medicare Advantage plan members with prescription drug coverage are enrolled in plans with at least four stars.
  • Check out a plan’s Star Rating, premiums, deductibles, coinsurance, out-of-pocket costs, benefits, and supplemental coverage when comparing Medicare Advantage plans.
  • Members can use Medicare’s Plan Finder tool to find what plans are available in their area.

What are five-star Medicare Advantage plans?

A five-star rating indicates a high-quality, high-performance plan. Medicare rates plans from one to five stars based on several factors.

The agency uses information from healthcare providers, member satisfaction surveys and the health plans themselves to determine the ratings. Medicare rates Medicare Advantage plans on up to 45 different quality and performance measures, including:

  • Breast cancer screening
  • Colorectal cancer screening
  • Diabetes care
  • Older adult care
  • Care coordination
  • Customer service
  • Health plan complaints
  • Members choosing to leave the plan
  • Promptness of appointments and care
  • Claims appeal process speed

Seventy-five percent of Medicare Advantage plans with prescription drug benefits received at least four stars for 2022. That's an increase of 28 plans in 2021. 

About 90% of Medicare Advantage plan members with prescription drug coverage are in a plan with at least four stars.

The best Medicare Advantage plans

Seventy-five percent of Medicare Advantage plans that offer prescription drug coverage received a five-star rating for 2022.

Here's an overview of the five-star Medicare Advantage plans for 2022.

Five-Star Medicare Advantage Plans for 2022
ContractContract nameParent organizationNumber of enrolledNon-Employer Group Health Plan service area
H0154Viva Health, Inc.Triton Health Systems49,828Alabama
H0169UnitedHealthcare of the MidwestUnitedHealth Group56,487Iowa, Kansas, Missouri, Nebraska
H0292Humana Health Plan of OhioHumana8,104Kentucky
H0294Care Improvement PlusUnitedHealth Group44,651Michigan, Wisconsin
H0332KS Plan AdministratorsKelsey-Seybold Medical Group39,100Texas
H0524Kaiser Foundation Health PlanKaiser Foundation Health Plan1,295,548California
H0630Kaiser Foundation Health Plan of ColoradoKaiser Foundation Health Plan112,250Colorado
H0710Sierra Health and Life Insurance CompanyUnitedHealth Group39,930Arizona, Colorado, Connecticut, Delaware, Florida, Georgia, Iowa, Illinois, Indiana, Maryland, Maine, Minnesota, Missouri, Mississippi, North Carolina, New Hampshire, New Jersey, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Virginia, Washington
H1019CarePlus Health PlansHumana196,637Florida
H1170Kaiser Foundation Health Plan of GeorgiaKaiser Foundation Health Plan33,989Georgia
H1230Kaiser Foundation Health PlanKaiser Foundation Health Plan34,310Hawaii
H1365Martin's Point Generations AdvantageMartin's Point Health Plan1,146Maine, New Hampshire
H1537Care Improvement PlusUnitedHealth Group2,117Alaska, Alabama, Arizona, Arkansas, Arizona, California, Colorado, Connecticut, District of Columbia, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Kansas, Kentucky, Lousiana, Massachusetts, Maryland, Maine, Michigan, Minnesota, Missouri, Mississippi, Montana, North Carolina, North Dakota, Nebraska, New Hampshire, New Jersey, New Mexico, Nevada, New York, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Vermont, Washington, Wisconsin, West Virginia, Wyoming
H1951Humana Health Benefit Plan of LouisianaHumana185,652Louisiana
H1961Peoples HealthUnitedHealth Group84,540Louisiana
H1994SelectHealthIntermountain Health Care40,095Idaho, Nevada, Utah
H2001Sierra Health and Life Insurance CompanyUnitedHealth Group1,524,329Maine, Utah
H2172Kaiser Foundation Health Plan of the Mid-Atlantic StatesKaiser Foundation Health Plan101,395Maryland, District of Columbia, Virginia
H2225Commonwealth Care AllianceCommonwealth Care Alliance12,058Massachusetts
H2226UnitedHealthcareUnitedHealth Group20,168Massachusetts
H2235BayCare Select Health PlansBayCare Select Health Plans11,126Florida
H2256Tufts Associated Health Maintenance OrganizationPoint32Health104,990Massachusetts
H2292Oxford Health InsuranceUnitedHealth Group8,638New York
H2416PrimeWest Rural MN Health Care Access InitiativePrimeWest Rural MN Health Care Access Initiative1,857Minnesota
H2419South Country Health AllianceSouth Country Health Alliance1,462Minnesota
H2422HealthPartnersHealthPartners4,876Minnesota
H2425Blue PlusAware Integrated8,388Minnesota
H2459UCare MinnesotaUCare Minnesota116,476Minnesota
H2462Group Health PlanHealthPartners4,157Minnesota, Nevada, South Dakota, Wisconsin
H2610Essence HealthcareEssence Group Holdings Corporation63,175Illinois, Missouri
H3344Independent Health Benefits CorporationIndependent Health Association5,766New York
H3351Excellus Health PlanLifetime Healthcare94,711New York
H3344Independent Health AssociationIndependent Health Association59,224New York
H3388Capital District Physicians' Health PlanCapital District Physicians' Health Plan42,258New York
H3416HealthPartners UnityPoint HealthHealthPartners UnityPoint Health3,104Iowa, Illinois
H3557Blue Cross & Blue Shield of Rhode IslandBlue Cross & Blue Shield of Rhode Island8,140Rhode Island
H3597AetnaCVS Health Corporation14,070Maine
H3664Aultman Health FoundationAultman Health15,407Ohio
H3794Care Improvement PlusUnitedHealth Group21,493Wisconsin
H3907UPMC Health SystemUPMC Health System154,545Ohio, Pennsylvania
H3916Highmark HealthHighmark Health161,520Pennsylvania
H3952Keystone Health PlanIndependence Health Group,82,851Pennsylvania
H3957Highmark ChoiceHighmark Health74,113Pennsylvania
H4152Blue Cross & Blue Shield of Rhode IslandBlue Cross & Blue Shield of Rhode Island54,115Rhode Island
H4172NHC AdvantageMissouri Healthcare Advisors925Missouri, South Carolina, Tennessee
H4461Cariten Health PlanHumana136,513Tennessee
H4497Medical Mutual of OhioMedical Mutual of Ohio8,241Ohio
H4590UnitedHealthcare Benefits of TexasUnitedHealth Group314,930Texas
H4882HealthPartnersHealthPartners35,878Minnesota, Wisconsin
H5010Asuris Northwest HealthCambia Health Solutions913Washington
H5042Capital District Physicians' Health PlanCapital District Physicians' Health Plan6,680New York
H5050Kaiser Health Plan of WashingtonKaiser Foundation Health Plan98,260Washington
H5087WellCare of CaliforniaCentene Corporation69,388California
H5209My Choice Wisconsin Health PlanMy Choice Wisconsin2,024Wisconsin
H5215Network HealthNetwork Health65,611Wisconsin
H5253UnitedHealthcare of WisconsinUnitedHealth Group679,094Arizona, Iowa, Illinois, Kentucky, North Carolina, Ohio, Tennessee, Virginia, Wisconsin
H5262Quartz Health Plan CorporationUniversity of Wisconsin Hospitals and Clincs23,024Iowa, Illinois, Wisconsin
H5386Sharp Health PlanSharp Healthcare6,997California
H5410Heatlhspring of FloridaCigna61,020Florida
H5420Medica Healthcare PlansUnitedHealth Group42,550Florida
H5431Healthsun Health PlansAnthem57,295Florida
H5522Healthassurance PennsylvaniaCVS Health Corporation86,216Pennsylvania
H5526Highmark Western and Northeastern New YorkHighmark Health18,265New York
H5533UPMC Health NetworkUPMC Health System7,875Pennsylvania
H5591Martin's Point Generations AdvantageMartin's Point Health Care53,423Maine, New Hampshire
H5594Optimum HealthcareAnthem52,655Florida
H5652Sierra Health and Life Insurance CompanyUnitedHealth Group5,301Colorado, Florida, Kansas, Massachusetts, Maryland, Michigan, North Carolina, New Jersey, Pennsylvania, Texas, Virginia
H5883Blue Care Network of MichiganBlue Cross Blue Shield of Michigan91,548Michigan
H5938Capital Health PlanGuidewell Mutual Holding Corporation22,950Florida
H9003Kaiser Foundation Heatlh PlanKaiser Foundation Health Plan101,266Oregon, Washington
H9047Providence Health AssuranceProvidence Health & Services61,891Oregon, Washington
H9096Dean Health PlanSSM Health Care Corporation8,467Wisconsin
H9808Care N Care Insurance Company of North CarolinaMoses H. Cone Memorial Hospital Corp.15,331North Carolina
H9834Quartz Health Plan CorporationUniversity of Wisconsin Hospitals and Clincs2,777Minnesota

What to think about when choosing a Medicare Advantage plan

While Medicare's rating system can steer you toward plans that rank highly on several quality and performance measures, it's still important to do your own research and find a plan that aligns best with your particular needs.

When comparing plans, pay close attention to what healthcare providers and hospitals are in the network. If you already receive care from a specific provider, double-check to make sure he or she is considered in-network under the plan. Also, call your doctor's office to make sure the provider accepts the plan before enrolling. Some providers may not accept specific Medicare Advantage plans.

Doing this extra legwork is important. Otherwise, you may incur extra costs for going out-of-network or have to switch to another provider who is within the plan's network or accepts this insurance.

Also, look at the:

  • Monthly premiums, which is what you pay for the coverage.
  • Deductibles, which is what you pay for health care services before the plan kicks in money.
  • Coinsurance, which is your portion of the health care services costs after you reach your deductible.

Some plans may offer a lower monthly premium in exchange for a higher deductible and coinsurance. Some plans may have a high out-of-pocket maximum, which is the most you'll pay for covered services each year.

Medicare has set the out-of-pocket cost limit at $7,550 for Medicare Advantage plans. However, some plans may have a lower out-of-pocket maximum, while some may be right at this threshold. You’ll want to weigh all of these costs and figure out whether you’d prefer to pay higher premiums or out-of-pocket costs.

Plan benefits are another critical factor. Look at whether the plan offers supplemental benefits, such as vision or dental coverage. If you take several prescription medications, see if the plan provides prescription drug coverage and what medications are listed in its formulary and covered by the insurer. If your medications aren't covered, shop around for another plan that better meets your needs.

Whether you've just become eligible for Medicare or are switching plans during a special enrollment period, you can use Medicare's Plan Finder tool to find Medicare Advantage plans offered in your area. Start there, but if you have additional questions or are unclear about potential costs or what is covered and what isn't, don't hesitate to call the insurer, talk to a representative and get clarification before you make a final decision.

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