CMS to add star ratings to health plans

CMS is planning to add a star ratings system to insurance plans offered through the individual exchange created from the Affordable Care Act, the agency announced August 15. The new ratings will be displayed for the 2020 open enrollment period on Healthcare.gov.

According to CMS, the change will help consumers make more informed decisions about their healthcare coverage, develop more oversight of health plans and give actionable information to health plans on how to improve the quality of services they provide.

“Knowledge is power, and for the first time, consumers will have access to meaningful, simple-to-use information to compare the quality, along with the price, of health plans on Exchange websites, including HealthCare.gov,” CMS Administrator Seema Verma said in a statement. “This addresses our strongly held commitment to equip consumers with the tools they need to find the best choice possible. Increasing transparency and competition drive better quality and cost, with consumers benefitting the most.”

Under the new plan, health plans will be given a star rating out of five stars, with five stars representing the highest quality. Plans will be rated across three categories, including member experience, medical care and plan administration, which will each have their own five-star rating scale.

In total, the quality rating system includes 38 quality measures, with 28 clinical quality measures focused on the quality of healthcare services provided and 10 survey measures from enrollees’ experience with their health plan. Consumers will see the star ratings on open enrollment or a notice if the plan hasn’t been rated.

The star ratings system for individual health plans follows a limited pilot program from CMS to add the ratings to some health plans in the 2017 and 2018 open enrollment periods. Healthcare providers that offer care under Medicare and Medicaid already are rated through a star rating system that gives patients more information.