Slide 1: CMS Centers for Medicare & Medicaid Services Part C and D Star Ratings Overview

June 2024
Slide 2: Overview
•	Medicare Advantage plans, including dual eligible Special Needs plans, get a rating from 1 to 5 stars.
•	The Star Ratings are based on how well a plan performs on up to approximately 40 different measures.
•	Star Ratings help Medicare beneficiaries shop for a plan that best meets their needs, but other factors also matter in choosing a plan.
•	Medicare Advantage plans with higher Star Ratings get more funding allowing them to offer more generous benefits, including supplemental benefits and lower premiums.
•	Therefore, Medicare Advantage organizations have a strong incentive to improve Star Ratings.
Slide 3: CMS Priorities
•	The Star Ratings Program is consistent with the “Meaningful Measures” framework
•	Focus on the highest priority areas for quality measurement and improvement, including to:
o	Promote effective communication and coordination of care
o	Promote effective prevention and treatment of chronic disease 
o	Work with communities to promote best practices of healthy living
o	Make care affordable
o	Make care safer by reducing harm caused by the delivery of care 
o	Strengthen person and family engagement as partners in their care
Slide 4: Release of Star Ratings
•	Star Ratings are released prior to October 15th each year based on performance in the prior year for most measures.
•	2025 Star Ratings to be released in October 2024 will be:
o	Based on performance during 2023 for most measures
o	The basis for the 2026 Quality Bonus Payment ratings.
Slide 5: Medicare Plan Finder Display
Note: this slide contains a screenshot of a medicare.gov/plan-compare web page. 

The plans shown are AARP Medicare Advantage Patriot No Rx DC-MA01 (PPO), CareFirst BlueCross BlueShield Advantage Core (HMO), and Kaiser Permanente Medicare Advantage Standard MD (HMO-POS)

These features are highlighted with a red arrow.
•	Plan’s Overall Star Rating
•	Click Plan Details to view all Star Ratings
•	Compare monthly payments
Slide 6: Medicare Plan Finder: Your Star Ratings Page
Note: this slide contains a screenshot of the medicare.gov Star Ratings web page that was referenced in Slide 5. The screenshot shows these rating details.

•	Overall star ratings 
Overall rating is based on the categories below.
•	Health plan star rating 
(this includes a hyperlink to “View how this plan compares to Original Medicare”)
•	Staying health: screenings, tests, & vaccines
o	Breast cancer screening
o	Colorectal cancer screening
o	Yearly flu vaccine
o	Monitoring physical activity
Slide 7: Medicare Plan Finder: Your Star Ratings Page (Comparison to Original Medicare)
You can also view how this plan compares to original Medicare

Note: this slide contains a screenshot of the medicare.gov web page that was referenced in Slide 5. The screenshot shows information on “View how this plan compares to Original Medicare”. 

It lists the rating categories and shows the comparisons between the Original Medicare ratings versus this plan’s ratings. The ratings are broken out in these categories:

•	Yearly flu vaccine 
•	Ease of getting needed care and seeing specialists
•	Getting appointments and care quickly
•	Health plan provides information or help when members need it.
•	Members’ rating of health care quality
•	Members rating of health plan
•	Coordination of members’ health care services
Slide 8: Medicare Plan Finder: Part D Summary Ratings
You can also see the breakdown of the Star Ratings for Part D

Note: this slide contains a screenshot of the medicare.gov web page that was referenced in Slide 5. The screenshot shows ratings for Medicare Part D. The ratings are broken out in these categories:

•	Overall star ratings 
Overall rating is based on the categories below.
•	Drug plan star rating
•	Drug plan customer service
o	Availability of TTY service and foreign language interpretation when prospective members call the drug plan”
•	Member complaints & changes in the drug plan’s performance
o	Complaints about the drug plan (more start are better because it means few complaints)
o	Members choosing to leave the plan (more stars are better because it means fewer members choose to leave the plan)
o	Improvement (if any) in the drug plan’s performance
+ Member experience with the drug plan
Slide 9: High Performing Plans and Low Performing Plans
High Performing Plans
•	CMS highlights contracts receiving 5 stars for their highest rating on MPF:
Note: an image is included under this bullet showing a star with the number 5 in the center of it with the following text beside the star, “This plan got Medicare’s highest rating (5 stars)”.
•	Beneficiaries may enroll in a 5-star MA-PD, MA-only, or PDP through a Special Election Period (SEP). 
•	5-star plans may market year-round.
•	Tend to focus on the needs of each enrollee rather than focusing on particular Star Ratings measures.
Low Performing Plans
•	Icon displayed for contracts rated less than 3 stars for at least the last 3 years in a row for their Part C and/or D summary rating.
Note: an image is included under this bullet showing a bold red triangle with a bold black exclamation mark in the center of it.
•	Beneficiaries cannot enroll online via the MPF in a Low Performing Icon (LPI) plan. Beneficiaries must contact the plan directly. 
•	Notices are sent to beneficiaries in LPI plans explaining they are eligible for an SEP to move to a higher quality plan.
•	Contracts with consistently low performance on Part C or consistently low performance on Part D for 3 consecutive years are eligible for termination from the program.
Slide 10: 2025 Star Ratings across 9 Domains
(42 measures for Parts C & D)
Note: the following ratings are shown in two tables on this slide.
Ratings of Health Plans (Part C)
•	Staying healthy: screenings, tests and vaccines
•	Managing chronic (long-term) conditions
•	Member experience with health plan
•	Member complaints and changes in the health plan’s performance
•	Health plan customer service
Ratings of Drug Plans (Part D)
•	Drug plan customer service
•	Member complaints and changes in the drug plan’s performance
•	Member experience with the drug plan
•	Drug safety and accuracy of drug pricing 
Slide 11: Ongoing Work Related to SRFs
•	Implementing a Health Equity Index (HEI) reward beginning with the 2027 Star Ratings to incentivize improved performance among enrollees with specified social risk factors (SRFs).
o	Included SRFs are receipt of low-income subsidy, dual eligibility, and disability. Additional SRFs may be added over time through rulemaking.
•	Added question related to perceived unfair treatment on the 2024 Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.
•	Beginning with the 2028 Star Ratings, adding sociodemographic risk adjustment of the three Part D Medication Adherence measures for age, gender, low income subsidy/dual eligible, and disability.
•	Planning to field test new Health Outcomes Survey questions on health-related social needs.
Slide 12: Stakeholder Input
•	We solicit input regarding the measures and methodology for the Star Ratings program through the Advance Notice/Rate Announcement Process link each year as well as through the rulemaking process.
Slide 13: Additional Resources
Part C & D Star Ratings and Display Measure data, Technical Notes, and other key information posted on CMS website: 
Part C and D Performance Data 

Mailbox for questions:
PartCandDStarRatings@cms.hhs.gov 
Slide 14: Appendix
Title slide only, no content on this slide
Slide 15: Structure of the Star Ratings
Note: this slide includes an image of a flowchart showing the connections between the following categories.
Overall
Weighted Average (whole & ½ stars)
	Overall Rating MA-PD
Summary
Weighted Average (whole & ½ stars)
	Part C Rating
		MA-Only & MA-PD
	Part D Rating
		MA-PD & PDP
Domain
Non-weighted Average (whole stars)
	Part C Rating
		HD1, HD2, HD3, HD4, and HD5
	Part D Rating
		DD1, DD2, DD3, and DD4
Measure
(numeric values & whole stars)
	Part C Rating
		C01 to Cnn
	Part D Rating
		D01 to Dnn
Slide 16: 2025 Star Ratings Measures - 1
Note: the following information is shown in a table on the slide and all slides going forward. The table columns include which Medicare Part the Measure is under (Part C or D), what measure it is, and what measure type it is. For clarity, the specific Measures are listed below under Part and Measure Type.
Part C, Measure Type:
•	Process Measure
o	Breast Cancer Screening 
o	Colorectal Cancer Screening 
o	Annual Flu Vaccine 
o	Monitoring Physical Activity 
o	Special Needs Plan (SNP) Care Management 
o	Care for Older Adults – Medication Review 
o	Care for Older Adults – Pain Assessment 
o	Osteoporosis Management in Women who had a Fracture 
•	Intermediate Outcome Measure 
o	Controlling Blood Pressure 
Slide 17: 2025 Star Ratings Measures – 2
Note: the following information is shown in a table on the slide and all slides going forward. The table columns include which Medicare Part the Measure is under (Part C or D), what measure it is, and what measure type it is. For clarity, the specific Measures are listed below under Part and Measure Type.

Part C, Measure Type:
•	Process Measure
o	Diabetes Care – Eye Exam 
o	Reducing the Risk of Falling 
o	Improving Bladder Control 
o	Medication Reconciliation Post-Discharge
o	Transitions of Care 
o	Follow-up after Emergency Room Visit 
•	Intermediate Outcome Measure 
o	Diabetes Care – Blood Sugar Controlled 
•	Outcome Measure
o	Plan All-Cause Readmissions 
•	Patients’ Experience and Complaints Measure 
o	Getting Needed Care 
Slide 18: 2025 Star Ratings Measures - 3
Note: the following information is shown in a table on the slide and all slides going forward. The table columns include which Medicare Part the Measure is under (Part C or D), what measure it is, and what measure type it is. For clarity, the specific Measures are listed below under Part and Measure Type.
Part C, Measure Type:
•	Patients’ Experience and Complaints Measure 
o	Getting Appointments and Care Quickly 
o	Customer Service 
o	Rating of Health Care Quality 
o	Getting Appointments and Care Quickly 
o	Customer Service 
o	Rating of Health Care Quality 
Slide 19: 2025 Star Ratings Measures - 4
Note: the following information is shown in a table on the slide and all slides going forward. The table columns include which Medicare Part the Measure is under (Part C or D), what measure it is, and what measure type it is. For clarity, the specific Measures are listed below under Part and Measure Type.

Part C, Measure Type:
•	Patients’ Experience and Complaints Measure
o	Members Choosing to Leave the Plan 
•	Improvement Measure
o	Health Plan Quality Improvement 
•	Measures Capturing Access
o	Plan Makes Timely Decisions about Appeals 
o	Reviewing Appeals Decisions 
o	Call Center – Foreign Language Interpreter and TTY Availability
•	Process Measure
o	Statin Therapy for Patients with Cardiovascular Disease 
Part D, Measure Type:
•	Patients’ Experience and Complaints Measure
o	Call Center – Foreign Language Interpreter and TTY Availability 
Slide 20: 2025 Star Ratings Measures - 5
Note: the following information is shown in a table on the slide and all slides going forward. The table columns include which Medicare Part the Measure is under (Part C or D), what measure it is, and what measure type it is. For clarity, the specific Measures are listed below under Part and Measure Type.
Part D, Measure Type:
•	Patients’ Experience and Complaints Measure
o	Complaints about the Drug Plan 
o	Members Choosing to Leave the Plan 
o	Rating of Drug Plan 
o	Getting Needed Prescription Drugs 
•	Improvement Measure
o	Drug Plan Quality Improvement 
•	Process Measure
o	MPF Price Accuracy 
Slide 21: 2025 Star Ratings Measures - 6
Note: the following information is shown in a table on the slide and all slides going forward. The table columns include which Medicare Part the Measure is under (Part C or D), what measure it is, and what measure type it is. For clarity, the specific Measures are listed below under Part and Measure Type.
Part D, Measure Type:
•	Intermediate Outcome Measure
o	Medication Adherence for Diabetes Medications 
o	Medication Adherence for Hypertension (RAS antagonists) 
o	Medication Adherence for Cholesterol (Statins) 
•	Process Measure
o	MTM Program Completion Rate for CMR 
o	Statin Use in Persons with Diabetes