Talking Medicare is the Senior Marketing Specialists weekly topic sheet. Information for agents to know for their clients, staff, and industry.

What are Star Ratings?

The Centers for Medicare & Medicaid Services (CMS) uses Star Ratings to rate the quality of Medicare Advantage (MA; Part C), including Special Needs Plans and Prescription Drug Plans (PDP; Part D). Star Ratings are also used to determine additional funding from CMS in the form of quality bonus payments and rebates. Star Ratings measure plans across a number of performance categories – including clinical quality, health plan operations and member satisfaction – on a scale of one to five, with five stars being the highest rating. The ratings are published annually in October at www.Medicare.gov. The 1-5 stars designation is shown below:

5 Star = Excellent    4 Star = Above Average    3 Star = Average    2 Star = Below Average    1 Star = Poor

What am I required to say or do when it relates to Star Ratings?

When presenting a MA or PDP to a consumer at a marketing/sales event, one-on-one appointment, or telephonically, you are required to say and do the following: State out loud what Star Ratings are, State out loud what the Star Rating is for the plan you are presenting (the rating is found in the Enrollment Guide for the plan you are presenting), Tell the audience/consumer the page where the Star Rating is located in the Enrollment Guide. Tell them they can find more information on www.Medicare.gov., Mention 1-2 measures CMS considers when establishing a Plan’s Star Ratings.

Examples you can mention:

  1. Member use of preventive care (such as annual screenings)
  2. Access to Care
  3. Member use of prescribed medications – use as prescribed to improve health (i.e., adherence)
  4. Customer satisfaction

Complete Medicare Basic Training Using Medicare Made Clear

Start on this link and work down through the selections on the right side of the page.

https://www.medicaremadeclear.com/basics/medicare-coverage-and-costs

Medicare Basics

  • Medicare Coverage & Costs
  • Medicare vs Medicaid
  • Who Can Get Medicare
  • Enrollment Time Periods
  • What Medicare Doesn’t Cover
  • Medicare Supplement Insurance
  • Get Help Paying for Medicare

What is a network pharmacy, and what is a preferred network pharmacy?

A network pharmacy is a pharmacy that a plan contracts with to offer drugs at a certain price. Some plans distinguish network pharmacies as preferred over other pharmacies, because they can offer better drug prices or better benefits.

Medicare Glossary of Terms

Follow the link below for a comprehensive list of terms used by Medicare:

https://www.medicare.gov/find-a-plan/staticpages/glossary/planfinder-glossary.aspx

Part D late enrollment penalty

The cost of the late enrollment penalty depends on how long you went without Part D or creditable prescription drug coverage. Medicare calculates the penalty by multiplying 1% of the “national base beneficiary premium”

($34.10 in 2016 / $35.63 in 2017) times the number of full, uncovered months you didn’t have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.

https://www.medicare.gov/part-d/costs/penalty/part-d-late-enrollment-penalty.html