Health Plan Star Ratings, Explained

While browsing Affordable Care Act (ACA) plans, you may have noticed that each one has a star rating from 1 to 5, 5 being the highest. We’re all fairly familiar with star ratings, as we see them all the time while ordering food from delivery apps, binge-watching, or shopping online. But what do these ratings mean in terms of health insurance? We’re glad you asked! Here’s what you need to know.

Health plan star rating origins

If you’ve never seen these ratings featured on the Health Insurance Marketplace before, that’s because they’re new for the 2020 plan year! Previously, the Centers for Medicare & Medicaid Services (CMS) was only using the 5-star rating system on Medicare plans. Each rated health plan has an “Overall” quality rating which accounts for member experience, medical care, and health plan administration. This gives you the ability to quickly compare plans based on quality.

What health plan star ratings are based on

Per healthcare.gov, a plan’s overall rating is determined by 3 different categories, each with its own star rating:

Member experience: Based on surveys of member satisfaction with both their health care and doctors, as well as ease of getting appointments and services.

Medical care: How well the plan’s network providers manage member health care, including the availability of regular screenings, vaccines, and other basic health services, as well as monitoring some conditions.

Plan administration: How well the plan is run, including customer service, access to needed information, and network providers ordering appropriate tests and treatment.

Who gets star ratings

Issuers offering plans on the exchange that offered coverage during the previous plan year and the current year and that have more than 500 enrollees must submit quality data to CMS, according to their fact sheet.

While browsing plans, you may notice that some do not currently feature a star rating. This does not mean that those plans are of low quality! If a plan is brand new or has low enrollment, the issuer simply did not meet the above requirements to submit data to CMS for 2020.

How the star ratings are calculated

CMS rates qualified health plans (QHPs) offered through the Exchanges using the Quality Rating System (QRS), which is based on third-party validated clinical measure data and QHP member survey response data. CMS calculates these ratings annually. QHP issuers contract with Health and Human Services (HHS) approved survey vendors that independently conduct the QHP member survey annually. Star ratings and QHP member survey results may differ from one year to the next.

What star ratings W3LL displays

W3LL complies with the CMS star rating guidelines to help you pick the plan that’s best for you! With our platform, you can see each plan’s overall rating on the “Plan Selection” page, as well as the plan’s member experience rating, medical care rating, and plan administration rating on the “Plan Details” page.

Ready to see the star ratings for yourself? Shop affordable health plans through W3LL now!

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