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Thursday, April 29, 2010

Most Medicare Advantage Enrollees Aren’t in Best Plans

By Katherine Hobson
From the Article in Wall Street Journal

A study finds that fewer than a quarter of Medicare Advantage participants are enrolled in plans rated very good or excellent by Medicare’s own rating system, the Associated Press reports.

The Avalere Health study, to be released today, finds that about 47% of participants are covered by plans receiving three or two stars, out of a possible five, under the government’s rating system. Only 23% are in four- or five-star plans, the AP says. And according to the consulting firm, 14% aren’t rated because they’re too new or lack the data required to score them.

Those scores will soon be used to do more than guide consumers; starting in 2012, better-scoring plans – four stars and up – will get higher payments from the government than lower-scoring ones. As Avalere President Dan Mendelson tells the AP, “When you start linking quality to payment, you can bet the plans are going to be very motivated to bring the scores up.”

An insurance industry spokesman tells the AP that it will be difficult for some plans to improve their ratings given the criteria – which include telephone customer service, success in managing chronic conditions and how many plan participants complain or quit.

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