Earlier this year, the Centers for Medicare and Medicaid Services (CMS) released the 2023 Star Ratings for Medicare Advantage (MA) and Part D plans. About half of MA plans that offer drug coverage will have a Star Rating of four or more in 2023, a drop from the 68% of plans with a four Star Rating (or higher) in 2022.
CMS publishes the Star Ratings every year to measure the quality of health and drug services received by consumers enrolled in MA or Part D plans. Plans are rated on a scale of one to five stars, with one star representing poor performance and five stars representing excellent performance. They aim to help consumers compare the quality of plans being offered so they can make the best health care decision for themselves. MA-only contracts (without prescription drug coverage) are rated on up to 28 measures while standalone Part D plans are rated on up to 12 measures.
The findings also showed than 72% of beneficiaries currently in an MA drug coverage plan are enrolled in one with four Stars or higher, a decline from 90% in 2022. The new findings show that record increases in plans with high Star Ratings are declining as regulatory flexibilities are going away in 2023. The average Star Rating was 4.37 in 2022 and will be 4.15 in 2023.
Additionally, there is one contract that is identified as a low performer for consistently low quality ratings. However, there were still some contracts that showed improvement as 11 contracts that received the 5-Star high performing icon in 2023 did not receive it in 2022.
Length of Time in Program
CMS noted that the higher Star Ratings are generally associated with contracts that have more experience in the MA program. MA plans with prescription drug coverage with ten or more years in the program are more likely to have four or more stars when compared to contracts with less than five years in the program. For stand-alone Part D contracts, the relationship is similar and those with more than ten years of experience do better when compared to those with less experience.
2023 and the COVID-19 PHE
For the 2023 Star Ratings, CMS only made measure-level adjustments for three Healthcare Effectiveness Data and Information Set (HEDIS) measures derived from the 2021 Health Outcomes Survey. The 2022 Star Ratings, in contrast, included measure-level adjustments for other non-Health Outcomes Survey measures under the extreme and uncontrollable circumstances rules.
CMS notes that “[t]he change in distribution from 2022 to 2023 Star Ratings is influenced by changes in measure scores, in both positive and negative directions, and the unusual circumstance of nearly all contracts qualifying for the regulatory adjustment for extreme and uncontrollable circumstances for the 2022 Star Ratings for most measures, resulting in higher than normal 2022 Star Ratings distributions.”
2023 Medicare Premiums
CMS also released the 2023 premium and coverage information, which were projected to be lower for both MA and basic Part D coverage when compared to 2022. Additionally, in 2023, people with Medicare prescription drug coverage will have additional benefits, including a $35 cost-sharing limit on a month’s supply of covered insulin products, as well as certain adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) at no additional cost.