Get acquainted

Medicare Star Ratings

Those little stars next to a Medicare Advantage or Prescription Drug Plan? They’re a big deal. They represent the Centers for Medicare & Medicaid Services’ (CMS’) impartial quality ratings, called Star Ratings.¹ Star Ratings—based on real Medicare beneficiaries’ experiences as well as objective measurements—help Medicare enrollees make informed and empowered decisions about which plans are right for them. Ratings are given annually on a 1-to-5-star scale, 1 being poor and 5 being excellent. More stars mean a better plan with fast service and high-quality coverage. 

A Quick Recap

On CAHPS surveys

CAHPS stands for Consumer Assessment of Healthcare Providers and Systems. Here’s a brief 101: 

  • WHAT: 15-minute or less survey to Medicare beneficiaries about their experiences (what happened and how often) with their healthcare providers and plans²
  • WHO COMPLETES SURVEYS: Medicare beneficiaries (assigned randomly)³  
  • WHO COLLECTS THE RESULTS: Agency for Healthcare Research and Quality (AHRQ), a federal agency charged with improving the safety and quality of America’s healthcare system² 
  • WHO USES THE DATA: Centers for Medicare & Medicaid Services (CMS), healthcare providers and plans to better understand patient experiences4 
  • WHEN THE SURVEYS OCCUR: March–June annually5
  • WHY CAHPS SURVEYS MATTER: CMS uses CAHPS survey responses to develop Medicare Star Ratings, which aim to empower beneficiaries to select the right plan for them with meaningful information about plan quality1 

Take a deeper dive into CAHPS below. 

  • What gets measured?

    CAHPS surveys aim to understand the range of interactions beneficiaries have with the healthcare system by asking about provider communication, timely access to care, coordinated care and access to information. Here are the measurement categories:6 

    • Getting appointments and care quickly 
    • Care coordination 
    • Getting needed care 
    • Customer service 
    • Getting needed drugs 
    • Overall rating—healthcare quality 
    • Overall rating—healthcare plan 
    • Overall rating—drug plan  

  • Which parts of the healthcare system get measured?

    CAHPS surveys ask about the full spectrum of the healthcare system from primary care to hospitals, mental health to health plans. CAHPS surveys seek to measure patients’ experiences wherever they encounter care whether that’s in a facility or at home.7 

    Providers7  

    • Clinicians and medical groups 
    • Hospices 
    • Home health care 
    • Surgical care 

     

    Condition-specific care7 

    • Cancer care 
    • Mental health care 

     

    Facility-based care7 

    • Hospitals 
    • Dialysis centers 
    • Nursing homes 
    • Outpatient ambulatory surgical centers 

     

    Health plans7 

    • Medical plans 
    • Dental plans 
    • Home- and community-based services 

  • Why should agents and members care about CAHPS surveys?

    Agents can help strategically identify where members face challenges or barriers to maximizing the benefits of their plan. Pay special attention to coverage education, customer service and helping them find the right care for them. 

    CAHPS surveys are how real people’s experiences get accounted for in the quality ratings. Medicare consumers use the Star Ratings to make informed choices.¹  

    CAHPS surveys matter to providers and health plans so they can compare and assess their performance to similar organizations, pinpointing strengths and weaknesses to develop plans to improve the member experience.4 


How you can help

Make a difference in member experience

As an agent, you play an important role for your clients. You’re often their first call when they have a question about their plan. They trust you. Honor that trust by being their go-to healthcare coverage advocate and resource. We’ll show you how. 

Coach them on coverage

Show your clients the ropes when it comes to their Summary of Benefits. Explain how they can see which services are covered and at what cost before seeing the doctor.  

Stellar customer service

Show them you put them and their needs first. Use Service Inquiries on Vantage to help yourself help your clients speedily and effectively. 

Provide provider support

Help clients find the right care for them—in person, virtually or at home—with Humana’s Find a Doctor tool with Care Highlight™ ratings. 

A knack for knowledge
Must-have agent resources

Sharpen your pencils and get ready to school yourself in delivering positive member experiences all year long with these three on-demand agent tutorials. 

Explore resources
Playbooks

3-30-60-90 Day Conversation Guide
This guide will help you onboard new members and have the right conversations.

Webinar

Six Tactics to Jumpstart Your Client...
Learn how to get your clients up to speed on their plans and why it matters in this webinar.

Webinar

Watch Time: 29 min

Springboard your success; OEP/SEP know how
In this webinar, you’ll learn the latest OEP updates and how to create your 2022 sales plan.

Tailored to you

One-on-one support

Got CAHPS survey or Medicare Star Ratings questions? Tee up your dedicated local Humana support team. Or feel free to call or email too. 

Find your team

¹https://www.cms.gov/files/document/2022-star-ratings-technical-notes-oct-4-2022.pdf
²https://www.ahrq.gov/cahps/faq/index.html
³https://ma-pdpcahps.org/globalassets/ma-pdp/home-page/2020-mapdp-cahps-qapts-v10—complete-manual—508-compliant.pdf
4https://www.ahrq.gov/cahps/faq/index.html
5https://www.ma-pdpcahps.org/en/faqs/faqs-for-contracts
6https://www.ahrq.gov/cahps/surveys-guidance/hp/about/survey-measures.html
7https://www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/understanding-cahps-101-infographic.pdf
*https://www.cms.gov/files/document/2022-star-ratings-fact-sheet1082021.pdf

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