Analysis: Variations in Advantage plans

WASHINGTON – A new analysis by the Kaiser Family Foundation has found substantial variations in the quality ratings of Medicare Advantage plans, even among the major health plans, as well as distinct patterns in terms of who is likeliest to have high vs. low ratings.
The Centers for Medicare & Medicaid Services (CMS) rates the relative quality of the private plans using a one- to five-star scale, with five stars representing the highest quality.
As Medicare.gov explains, the ratings reflect each health plan’s combined score on 33 measures in five categories: preventive care, management of chronic conditions, member satisfaction and plan responsiveness, complaint rates and attrition, and the quality of telephone customer service.
Currently, not one of the Advantage plans available in Rhode Island scores four or five stars, but several – including the AARP plans provided through a division of UnitedHealth Group, and the BlueCHiP plans from Blue Cross & Blue Shield of Rhode Island – get three and a half.
In Massachusetts, meanwhile, several plans get four and a half stars, including one from Blue Cross and Blue Shield of Massachusetts and several from Tufts Health Plan.
In its national analysis, the Kaiser team found that in general, private fee-for-service plans and regional preferred provider organizations (PPOs) have below-average ratings, significantly lower than HMOs and local PPOs.
Nonprofit plans have significantly higher average ratings than for-profit plans, Kaiser also found. And more experienced plans, with contracts going back before 2004, have higher ratings than newer ones (really new ones are generally unrated).
Overall, the study found, nearly one in four Medicare Advantage enrollees (23 percent) is in plans with four or more stars, but that varies considerably. In 25 states and Washington, D.C., less than 2 percent of enrollees are in such a plan, whereas in Massachusetts, Oregon and Hawaii, more than half are enrolled in such plans.
The analysis used the ratings posted by CMS on the Medicare Compare Web site, plus additional information from the CMS Plan Directory and enrollment files. It did not attempt to assess the validity of the quality ratings.
The study, “What’s in the Stars? Quality Ratings of Medicare Advantage Plans, 2010,” is available online.