Why do qualified health plans have star ratings?
All ACA-compliant plans (aka Qualified Health Plans or QHPs) with five hundred or more enrollees must have a star rating. The purpose of the star rating is to make it easier for you, the consumer, to make direct comparisons with similar plans offered by different insurance providers. The ratings help you to make better-informed decisions when choosing a health plan for yourself and your dependents.
We have used the star rating system for many years. We recognize its value when we make most major purchases, especially when service is a significant factor. Think hotels, think airlines, think restaurants. And now you can think health insurance.
Since Open Enrollment in 2020 (the plan year 2021), the Quality Rating System has provided consumers with easily understood information to compare healthcare plans’ quality, price, and performance on exchange websites (state and private, including TrueCoverage).’
For the plan year 2024, the average enrollee has a choice of over six issuers (insurance providers) on their state exchange and more than that if you choose a private exchange. Each provider must offer plans in your state on at least two of the metal tiers. You will have a choice of provider networks (e.g., HMO PPO). You will also consider the benefits of premium tax allowances and the cost-sharing reductions (CSRs) available in your state. Many of these decisions depend on your individual circumstances, e.g., your choice of medication, branded or generic, but the ‘STAR RATING’ may help you with some help with factors beyond your control.
What do the star ratings tell us?
Like most five-star Quality Rating Systems, the rating (5 stars is best) reflects the service provider’s (the insurance company) performance in critical areas.
In this case
- Medical care
- Member experience
- Plan Administration
PLUS
- Overall Rating
Medical care
- The medical care assessment is based on how well the healthcare providers within the plan’s network manage member’s healthcare. This includes providing regular screenings, chronic disease management, vaccines, and other essential health services
Member experience
- The Member Experience star rating is based on member satisfaction surveys focusing on their healthcare providers and doctors and the ease of access, e.g., appointments, services, and complaints.
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 are facilitating appropriate tests and treatment in a timely fashion.
The QRS (Quality Rating System) is a constructive initiative by the CMS (Centers for Medicare and Medicaid Services) to provide enrollees with an independent tool for assessing the appropriateness and quality of the health plans offered through the Health Insurance exchanges.
A star rating system may seem simplistic, but it is based on over 38 measurements of Medical Care, User satisfaction, and administrative excellence.
Where can I find the rating of my plan?
Before checking a plan’s star rating, it is probably best to find the two or three plans that best suit your needs and then compare the star ratings. Remember, the ratings spring directly from QHP enrollee surveys. They are not recommendations or endorsements of the federal government or the exchange, whether Federal, State, or private.
All health insurance independent agents/brokers must be able to show you the star ratings of any QHP available in your state. The agent’s job is to help you to choose the best plan for your medical needs and financial resources. The QRS may help you make your final decision.
Whom can I ask?
If you are unaware of your plan’s star rating, it makes sense to check with a qualified independent health insurance agent/broker well before open enrollment for 2025 (November 1st, 2024-January 15th,2025). If you expect to have Special Enrollment Period (SEP) before then, do it now. It is an opportunity to use your new information to save money or improve your health insurance coverage.
