You don’t have much time left to enroll (open enrollment ends December 15th) but for 2020 CMS (Centers for Medicare and Medicaid Services) has moved to make your choices better informed.
All Insurers (Carriers) are now required to display a ‘STAR RATING’ for any of their policies offered on Health insurance exchanges (Federal, State or private).
What does the STAR RATING tell us?
Like most five-star Quality Rating Systems the overall rating (5 stars is best) reflects the performance in key areas of the service being delivered.
In this case
- Medical care
- Member experience
- Plan Administration
The Quality Rating System (QRS) will provide you with easily understood information to compare the quality and performance of comparable health care plans available on exchange websites.
- MEDICAL CARE
- The medical care assessment is based on how well the health care providers in the plan’s network manage member’s healthcare.
- This includes providing regular screenings, vaccines, and other basic health services
- Monitoring some conditions
2. MEMBER EXPERIENCE
- The member experience assessment is based on surveys of member satisfaction with:
- Their healthcare and doctors
- Ease of getting appointments and obtaining services
3. PLAN ADMINISTRATION
- This is a measure of how effectively a plan is run. The rating takes account of
- Customer Service
- Availability of necessary information appropriately presented
- Network providers facilitating appropriate tests and treatment in a timely fashion
SUMMARY
The QRS (Quality Rating System) is a positive contribution to ensuring that enrollees have an independent tool for assessing the appropriateness and quality of qualifying the health plans available through the Health Insurance exchanges.
A star rating system may seem simplistic, but it is based on over 35 measurements of Medical Care, User satisfaction and Administrative excellence. All plan ratings are calculated in the same way.
How does the STAR RATING work?
The choice of metal Bronze, Silver, Gold or Platinum is unchanged. Your decision should be based on your expected healthcare needs in 2020.
Let’s assume you decide on a Silver Plan. Your exchange (either in person or electronically) will offer you several plans from different insurers. IT may be tempting to choose the least expensive premium between comparable offerings.
The QRS will allow you make your decision based on independent quality assessments.
You may still choose the cheapest plan but it will be a significantly better-informed decision!
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