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? Preventives measures are a series of health indicators that we all must comply with to stay healthy. These measures fluctuate according to age, gender and existing health conditions. Complying with preventive measures on time helps your health conditions under control and live with a better quality of life. Preventive tests for women: Preventive measure: Breast Cancer Screening Test: Mammography Who should have this test: Women between 50 and 74 years old Frequency: Every two years Preventive measure: Osteoporosis Management in Women Had a Fracture Description: Bone Density Test Who should have this test: Women 67-85 years of age or after a fracture (within the first six months) Frequency: Every two years Preventive measures for people 65 years of age or older: Preventive measure: Colorectal Cancer Screening Test: May be one of the following: Fecal Occult Blood (once a year) Sigmoidoscopy (every five years) Colonoscopy (every ten years) Who should have this test: Anyone from 50 to 75 years old Preventive measure: Flu Vaccine Description: Vaccine to prevent the spread of influenza Who should be vaccinated: Everyone over 50 years of age Frequency: Once a year Preventive tests for patients with diabetes: Preventive measure: A1c Control for Patients with Diabetes Test: Laboratory blood test (HbA1c) Who should have this test: Any person with a diagnosis of type I and type II diabetes; between the ages of 18 to 75 years Frequency: Every 3 to 6 months (recommended result: less than 9%) Preventive measure: Eye Exam for Patients with Diabetes Description: Test for the detection of diabetic retinopathy. Who should have this test: Any person with a diagnosis of type I and type II diabetes; between the ages of 18 to 75 years Frequency: Every year Preventive measure: Kidney Health Evaluation Description: Kidney function test. Test: Blood test and urine test. Estimated glomerular filtration rate test (eGFR) Albumin-creatinine test (uACR) Who should have this test: Any person with a diagnosis of type I and type II diabetes; between the ages of 18 to 85 years 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
