What Is a Five-Star Medicare Plan?

Lucy Lazarony
November 3, 2020

Wondering about the five-star ranking on a Medicare Advantage plan? Medicare uses information from member satisfaction surveys and healthcare providers to give overall performance star ratings to plans. A plan can get between one and five stars. A five-star rating is best and indicates an excellent rating.

So when you are shopping for Medicare Advantage plans keep your eyes out for the ratings of each plan, knowing that a five-star rating is best. These ratings from Medicare make it easy to compare plans based on quality and performance. Medicare updates these ratings each fall for the following year. So you don’t have to worry about a rating being out-of-date.

So when you are shopping for a Medicare Advantage plan, look for a rating to guide your decision-making for a new plan.

What Is Medicare Advantage?

Medicare Advantage plans are a type of Medicare health plan offered by private companies that contract with Medicare to provide all the Medicare Part A and Medicare Part B benefits and services. Most Medicare Advantage plans also offer prescription drugs coverage and additional benefits such as vision, hearing and dental bundled together.

A Medicare Advantage plan with five stars would be a plan of excellent quality. But is it a price you can afford? You need to be able to afford the plan with a high rating. Maybe a more cost-effective plan is better for your limited income? Would a three star or four star plan do?

Things to Consider Before You Buy

Here are some key things to think about when choosing a Medicare Advantage plan.

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Assess Medical Needs. Think about your medical needs for the upcoming year. Do you have some routine prescriptions that you take? Do you have a specialist that you see from time to time or are your healthcare needs more intensive? Write down your medical needs and expenses that you expect to pay in the upcoming year. With Medicare, you can change plans after a year so when your medical needs change so can your plan. What is most paramount for your healthcare in the next year? Once you know, it makes it easier to shop for a plan.

Review Your Current Medicare Plan. What Medicare plan do you have right now? How is the plan meeting your healthcare needs? How are the out-of-pocket costs? Do you like your doctors or are you thinking about a change? How much did you spend on medications for the past year? Are you thinking about a different prescription drug coverage? Review all aspects of your Medicare coverage in the past year. Were you satisfied or are you ready for a change?

Use Medicare Plan Finder. When you shop and compare Medicare Advantage plans and Part D prescription drug plans with SmartFinancial, you’ll be able to compare premiums and copayments for the plans in your area. An agent will also help you determine your out-of-pocket costs for prescription drugs.

Zero in on Doctor Costs. Will all of your doctors be covered with a new plan? Do you travel a lot? What would happen if you used an out-of-network doctor in another part of the United States? How much did you spend on doctor visits in the past year? Would you like a different doctor or are you happy with the one that you’ve got? Ask plenty of questions after you connect with an agent.

Check Pharmacy Costs. What is the preferred pharmacy for your medical plan? Your co-payments are lowest if you use a preferred pharmacy and you want to keep costs as low as they can go. How close and convenient is the preferred pharmacy to your house? You’ll want a pharmacy that is easy to get to when you have prescriptions to fill each month.

Check Cost Limit. If you join a Medicare Advantage plan, once you reach a certain limit you’ll pay nothing for covered services for the rest of the year. So check what that limit is. How easy will it be for you to reach that limit? Compare the cost limits for different Medicare Advantage plans. Which one makes the most sense for you? And if you are happy with your plan you can always stay put.

Doctor and Hospital Choices. Do the doctors you like accept the coverage that you are considering buying? Are you prepared to change doctors for a better deal on coverage? Do you have to choose your doctor or healthcare provider from a specific network? Is there an in-network hospital near you if you should need it?

Be sure the doctors that you want are accepting new patients. Do you need to get referrals to get to the doctors that you want? Finding the doctor that is right for you is an important part of your healthcare. So mull over these questions. You want the best doctor and best hospital choice for your care.

Vision, Hearing and Dental. These services are in your Medicare Advantage plan. Did you use them? Do you plan to use them in the upcoming year? Are you getting a new pair of glasses? Do you have dental work that you no longer can put off? Make sure the plan covers these items and the cost is something you can afford.

Weigh the pros and cons of each Medicare Advantage plan carefully. Look at the costs and the services provided and look at the star quality rating. Is the plan that best meets your needs five-stars? You can be assured it is of excellent quality and performance if it is.

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