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2018 Medicare Star Ratings

What are star ratings?

The Centers for Medicare and Medicaid Services (CMS) created a five star rating system to measure the quality and performance of Medicare Advantage and prescription drug plans. Ratings range from 1 to 5 stars, with five being the highest and one being the lowest. Ratings are based on the following five categories:

  1. Staying healthy: screenings, tests and vaccines.
    How well the plan works to detect and prevent illness. Also rates how well the plan improves and maintains physical and mental health of its members (e.g., whether members get screening tests, vaccines and other check-ups to help them stay healthy).

  2. Managing chronic (long-term) conditions.
    How well plans help members with chronic or long-lasting health conditions. (e.g., are members getting recommended care and how often are they readmitted to the hospital).

  3. Member experience with the health plan.
    How well the plan performed on Medicare’s member experience survey (the ease of getting appointments and care, information, coordination of the members’ health care services, members’ overall ratings of the plan).

  4. Member complaints, problems getting services, and choosing to leave the plan.
    How often members have problems with the plan, how often members leave the plan, and how much the plan’s performance has improved (if at all) over time.

  5. Health plan customer service.
    How the plan performs in customer service areas (how quickly and how well the plan handles member appeals).

For plans covering prescription drugs, this is an overall rating for the quality of prescription-related services that fall into the following four categories:

  1. Drug plan customer service.
  2. Member complaints, problems getting services, and choosing to leave the plan.
  3. Member experience with the drug plan.
  4. Drug pricing and patient safety.

In the fall of each year, Medicare reviews a plan’s performance and releases new star ratings. Therefore, our star ratings may change from year to year.

star performance icon our star ratings

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BlueShield of Northeastern New York is a Medicare Advantage plan with a Medicare contract and enrollment depends on contract renewal.This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or coinsurance may change January 1 of each year. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.You must continue to pay your Medicare Part B Premium.Out-of-network/non-contracted providers are under no obligation to treat BlueShield of Northeastern New York members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next. A division of HealthNow New York Inc., an independent licensee of the BlueCross BlueShield Association. A salesperson will be present with information and applications. For accommodations of persons with special needs at sales meetings, please call 1-800-258-7453 (TTY 711). BlueShield of Northeastern New York complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-833-735-4515 (TTY: 711). 注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-833-735-4515  (TTY: 711).

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Content Last Updated June 18, 2018