MA, Part D Contracts See Lower 2023 Medicare Advantage Star Ratings

The average star ratings for Medicare Advantage plans with prescription drug coverage and Part D plans were 4.15 and 3.25, which marked decreases from last year, the 2023 Medicare Advantage Star Ratings revealed.

The Medicare Advantage Star Ratings measure the quality of health and drug services received by individuals enrolled in Medicare Advantage and Part D plans. The ratings allow consumers to compare plan performances as they prepare for open enrollment.

The average 2023 star rating for Medicare Advantage-prescription drug contracts was 4.15, falling from 4.37 in 2022.

Around half of the Medicare Advantage-prescription drug plans (260 contracts) received a four-star rating or higher. Nearly three-quarters of enrollees currently have plans that received four or more stars.

The average 2023 star rating for standalone Part D contracts was 3.25, compared to 3.70 in 2022. Sixteen Part D contracts received four or more stars, representing about 9 percent of enrollees.

Among all the plans, 62 contracts earned five-star ratings, 57 of which were Medicare Advantage-prescription drug contracts. Two contracts were Part D plans and three were 1876 Cost Contracts. Eleven of the five-star contracts did not accomplish this feat in 2022.

One contract received a low-performing icon, which indicates consistent low-quality ratings. No contracts received this warning in the 2022 ratings, CMS noted.

Nonprofit organizations were more likely to receive higher ratings than for-profit organizations. For example, 72 percent of nonprofit Medicare Advantage-prescription drug contracts earned four or more stars compared to 43 percent of for-profit contracts. Similarly, 42 percent of nonprofit Part D plans received four or more stars compared to 25 percent of for-profit plans.

Additionally, Medicare Advantage contracts that have been in the program for ten or more years were more likely to have four or more stars compared to contracts with less than five years of experience.

Medicare Advantage-prescription drug contracts are rated on up to 38 quality and performance measures, while Part D contracts are rated on up to 12 measures.

From 2022 to 2023, Medicare Advantage-prescription drug contracts saw decreases in performance scores for all measures except for statin use in persons with diabetes (1.98 increase) and medication adherence for hypertension (0.16 increase).

The star ratings for all measures for Medicare Advantage-prescription drug contracts and Part D contracts also dropped, except for Medicare Plan Finder price accuracy.

CMS implemented several methodology changes for the 2023 star ratings.

In 2022, the agency applied a COVID-19-related provision allowing contracts to use the “better of” current or historical performance for most measures. However, this was not applied to 2023 ratings.

Additionally, CMS introduced guardrails for all measures that have been in the rating program for more than three years, except for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and improvement measures.

“Guardrails are bi-directional caps that restrict upward and downward movement of a measure’s cut points for the current year’s measure-level Star Ratings compared to the prior year’s measure-threshold specific cut points,” CMS wrote.

The weight of patient experience/complaints and access measures also increased from two to four for the 2023 star ratings.

Stakeholders expected the star ratings to fall for 2023 due to these methodology changes. Despite the reductions, healthcare industry leaders remain optimistic about the star ratings.

“CMS’s announcement shows that, even amid the impact of the ongoing public health emergency and recent methodological changes, Medicare Advantage continues to deliver high-quality care for seniors,” Mary Beth Donahue, president and chief executive officer of the Better Medicare Alliance, said in a statement. “In fact, the number of 5, 4.5, and 4-star Medicare Advantage plan contracts is higher for 2023 than just two years ago, in 2021.”

AHIP expressed similar sentiments.

“The ongoing and continuing effects of factors such as COVID-19, along with recent CMS methodological and measurement changes, may have affected the 2023 star ratings results, which primarily relate to the 2021 performance year,” Matt Eyles, president and chief executive officer of AHIP, said. “Even so, the majority of Medicare Advantage enrollees are projected to be covered by high-performing plans. AHIP and our member plans will continue to review the latest Star Ratings results and data closely to assess impacts.”