Medicare Star Rating

What is the Medicare Star Rating?

Every year, the Centers for Medicare and Medicaid Services (CMS) complete a performance evaluation of all health plans offering Medicare Advantage coverage. CMS gives the plans a score between 1 and 5 Stars, based on the evaluated areas. Some of these areas include:

  • How our members evaluate the health plan’s medical and health care services
  • How well preventive care and condition management is provided
  • How well the plan helps members with their prescription drugs

This assessment is divided into Health Services and Drug Services, obtaining an overall result between the two. This score can vary from year to year, and it greatly depends on member adherence to their health care and medical treatment.

How can I help my plan improve its Stars?

An important part of the Star Rating is the member’s adherence to preventive tests, management of existing conditions, and adequate drug use. We advise you to talk with your primary care doctor or a trusted physician to get these tests done. Your doctor can help you find alternatives to manage your health conditions.

What are preventive tests?

Preventive tests are performed in order to prevent any health complications or changes in your current health condition. Adhering to these preventive tests will help you stay healthy and achieve a better quality of life.

  • Test: Breast Cancer Screening
    Description: Mammogram
    Who should have this test performed? All women between 50 and 74 years old.
    Frequency: Once every two years.
  • Test: Colorectal Cancer Screening
    Description: May be one of the following:

    • Fecal Occult Blood Test
    • Colonoscopy
    • Sigmoidoscopy
  • Who should have this test performed? All adults between 50 and 75 years old.
    Frequency: Depending on the test, once a year to once every 10 years.

  • Test: Glycated Hemoglobin (A1c)
    Description: Blood sugar levels lab test
    Who should have this test performed? All diagnosed diabetics between 18 and 75 years old.
    Frequency: Every six months or once a year.

  • Test: Flu Vaccine
    Description: Vaccine to prevent flu (influenza).
    Who should have this test performed? All adults over 50 years old.
    Frequency: Once a year.

  • Test: Eye Exam for Diabetics
    Description: Eye exam to detect diabetic retinopathy.
    Who should have this test performed? All diagnosed diabetics between 18 and 75 years old.
    Frequency: Once a year.

  • Test: Bone Density Test
    Description: Preventive test for the early detection of osteoporosis.
    Who should have this test performed? All women over 65 years old.
    Frequency: Once a year.

  • Test: Kidney Disease Prevention for Diabetics
    Description: Kidney function test.
    Who should have this test performed? All diagnosed diabetics between 18 and 75 years old.
    Frequency: Once a year.

Remember to talk to your doctor about the following topics:

  • Bladder Control Problems (urinary incontinence)
  • Preventing Falls
  • Recommendations for Physical Activity
  • Nutrition
  • General Care for Your Physical and Mental Health
  • Advance Directives

Last update: 10/04/2017

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