Fewer MA Plans See High Medicare Advantage Star Ratings in 2021

If beneficiaries were to choose the same health plan for 2021 as they did for 2020, slightly over 19 percent of Medicare Advantage beneficiaries would be enrolled in plans with a 4.5 Medicare Advantage Star Rating, Avalere researchers found.

This represents an 11.8 percentage point decrease from the previous year.

Avalere looked at 2020 Medicare Advantage enrollment numbers in context of Star Rating reports for 2021, the organization explained.

“Avalere’s 2020 analysis measures the distribution of enrollees based on their 2021 Star Ratings. These enrollment percentages could shift in 2021 following the annual election period that runs until December 7,” the researchers noted.

In 2020, 42.4 percent of beneficiaries were in health plans scoring 4.5 stars or more. In 2019, the percentage was lower than in 2020 but still higher than the projections for 2021. Avalere predicted that 35.3 percent of enrollees will be in plans with a 4.5 or higher Medicare Advantage star rating.

Since fewer plans scored a 4.0 on the Medicare Advantage Star Ratings, 7.9 percent fewer enrollees would be in 4.0-star plans in 2021 than in 2020, assuming enrollees remained in the same plans that they chose for 2020.

Enrollment in plans with 3.5 stars could see a significant increase in 2021 enrollment. This population grew 17.9 percentage points over enrollment in 2020 to hit 33.7 percent.

Nearly 4.0 percent of enrollees (3.9 percent) would be enrolled in a plan that scored 3.0, should members choose the same plan as in 2020.

Medicare Advantage plans are not alone in this decline in enrollment distribution in high-rated plans.

If prescription drug plan enrollees choose the same plans as last year, prescription drug plans will see an increase in enrollment distribution in 3.5 star-rated plans, from 42 percent in 2020 to 82 percent in 2021. The researchers attributed this to the decrease in the number of prescription drug plans with 4.0 stars and the decrease in individuals in plans with 3.0 stars.

Also, nearly one-quarter of Medicare Advantage enrollees would be in Medicare Advantage-prescription drug plans that experienced a drop in their star rating scores. Fifteen percent of Medicare Advantage-prescription drug plan enrollees would be in plans that declined from a 4.5 star rating.

That being said, the majority of enrollees (68 percent) would end up plans that did not change in their Medicare Advantage Star Ratings at all.

However, CMS focused on certain continued positive trend among Medicare Advantage Star Ratings. Twenty-eight Medicare Advantage-prescription drug plans and prescription drug plans received a five-star Medicare Advantage Star Rating, five more plans than the prior year.

“Between 2020 and 2021, there was a small downward shift in the enrollment-weighted mean rating,” the CMS fact sheet acknowledged.

Relatedly, CMS also announced average premium decreases and increases in benefit richness and comprehensiveness, two more trends that have emerged over the past few years.

CMS expected Medicare Advantage average premiums to decline 34.2 percent over their 2017 levels, the lowest since 2007.

The agency also indicated that enrollment would be 44 percent higher since 2017.

Meanwhile, plans are especially bolstering their chronic disease management benefits and 94 percent of Medicare Advantage plans will offer additional telehealth benefits.

However, many—including the Avalere researchers—are concerned about the impact that coronavirus will have on Medicare Advantage Star Ratings in the coming years.

Referring to the decrease in the number of beneficiaries in 4.5-star Medicare Advantage plans, the Avalere researchers projected:

“This reduction will have an impact on payment for 2022, as the star ratings for 2021 are used to determine payment for 2022.”

According to a separate Avalere report from August 2020, CMS took two actions to counteract the pandemic’s effect on Medicare Advantage Star Ratings and MedPac also released guidance on the matter.

Nevertheless, the experts anticipated negative impacts.

“Plans with 4 stars or higher that receive an increase in their benchmarks could be at risk for losing part or all of their payment ‘bonus,’” the researchers stated. “Stakeholders can anticipate that these proposed changes may move separately and can develop customized engagement strategies with the CMS and Congress around certain components.”