Medicare beneficiaries can choose original Medicare fee-for-service (Part A and Part B) or select one of the health plans offered by private insurers under the Medicare Advantage program. To enable beneficiaries to make an informed choice on private plans, the federal Medicare agency collects information on the plans, including beneficiary satisfaction surveys and objective measures such as patient outcomes data. This information is compiled, analyzed and converted into a plan rating ranging from a low of one star to a high of five stars.
Highest Rated Plan Types
The Kaiser Family Foundation (KFF) uses the plan ratings developed by the federal government to compile annual reports on the top private Medicare plans and plan types.
According to the 2009 report, nonprofit Medicare plans have significantly higher ratings than their for-profit counterparts. Experience in serving Medicare beneficiaries is another indicator of quality service, with more established plans consistently scoring higher than newer entrants into the Medicare market. Private fee-for-service (PFFS) and regional preferred provider organizations (PPOs) are generally rated as below average. Smaller local PPOs and HMO-style Medicare Advantage plans are more likely to receive above-average ratings.
Another important factor in finding the highest-rated Medicare Advantage plan is whether it has been the subject of a federal enforcement action. Enforcement actions can result from beneficiary or provider complaints, fraudulent billing, or other problems. To find out whether a specific Medicare plan was involved in an enforcement action requiring correction, follow the Corrective action plans link in the Resources section.
The 2010 KFF report analyzed two years of data and found that HMO Medicare plans administered by Kaiser Permanente receive the highest scores (approximately four out of five stars) among HMOs, with plans run by Highmark coming in a close second.
Kaiser's six rated plans enrolled over 800,000 Medicare beneficiaries. The Highmark score was based upon one rated plan with an enrollment of approximately 175,000 beneficiaries.
The Medicare plan directory and Medicare plan compare tool in the Resources section can help you to determine if these Medicare plans are available in your area or to find the highest-rated local plan.
Highest Rated PPOs
Aetna's PPO achieved the highest rating for local PPOs, according to the KFF reports (3.5 stars). Highmark, again, ranked high with 3.45 stars for its two rated local PPO Medicare plans. The smaller local PPOs garnered high ratings (3.46 stars) as well. The KFF report ranks these plans together under the heading "All Other Organizations."
The Medicare plan directory and Medicare plan compare tool in the Resources section can guide beneficiaries in locating an Aetna, Highmark, or other PPO plan available locally.