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Looking For The Advantages In Medicare Advantage Plans: Senior Buyer Be Aware

December 14, 2009
The non-profit Kaiser Family Foundation recently released an analysis of current quality ratings of Medicare Advantage plans based on the five-star system published by the Centers for Medicare and Medicaid Services on the Medicare Compare website, with additional information from the CMS Plan Directory and enrollment files. The analysis examines the summary scores for the plans, which are an overall measure of the quality of care, access to care, responsiveness, and beneficiary satisfaction provided by the plans. While the report does not in any way attempt to assess the validity of the quality ratings, the information it provides can help beneficiaries considering enrolling in one of the private plans by providing some basis for comparison. The analysis examined the summary scores for the plans and the scores from the individual measures, which may be even more relevant to some people. Researchers found that quality ratings vary by plan characteristics. Private Fee-For-Service plans and regional Preferred Provider Organizations (PPOs) have below average ratings, significantly lower than HMOs and local PPOs. Non-profit plans have significantly higher average ratings than for-profit plans. More experienced plans (with contracts beginning before 2004) have higher ratings than newer ones, and average quality ratings vary widely among the largest organizations offering Medicare Advantage plans, with many surprises. Overall, barely one in four Medicare Advantage enrollees is in a plan with four or more stars—that means not even 25 percent—and less than 1 percent are in plans rated as 5 stars. What’s more, the share of enrollees in highly rated plans varies greatly by state–from less than 2 percent in 25 states and Washington DC to more than half in Massachusetts, Oregon and Hawaii. To read the entire report, go to http://www.kff.org/medicare/upload/8025.pdf while the window of opportunity to change your plan is still open.