Experience, nonprofit status mean high star ratings for Medicare Advantage contracts

CMS headquarters-Maryland

The Centers for Medicare and Medicaid Services rated 23 Medicare Advantage contracts out of more than 600 as having five stars, the highest ranking in CMS's five-star ratings released this week.

The star ratings measure quality and determine bonus payments.

Of the 178 Medicare Advantage plans that include Part D contracts, 14 received five stars. None received two stars; the average rating was four stars, according to CMS.

A further breakdown shows three high performers are Medicare Advantage-only plans, and six are prescription drug program contracts.

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The 14 MA-Part D plans receiving five stars are: KS Plan Administrators in Texas; Kaiser Foundation HP in California; Kaiser Foundation HP in Colorado; Kaiser Foundation of the Mid-Atlantic states; Tufts Associated HMO in Massachusetts; BCBS of Massachusetts HMO Blue; Group Health Plan in Minnesota and Wisconsin; Aultcare Health in Ohio; Physicians Health Choice of Texas;  CDPHP Universal Benefits in New York; Gundersen Health Plan in Iowa and Wisconsin; Optimum Healthcare in Florida; Sierra Health and Life in several states; and Kaiser Foundation HP of the NW in Oregon and Washington.

The three Medicare Advantage-only contracts are: Medical Associates Health Plan in Illinois; Dean Health Plan in Wisconsin and Kaiser Foundation HP in California.

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The six prescription drug plan contracts getting five stars are: Tufts Insurance Company; AnthemBCBS in Massachusetts, Rhode Island and Vermont; Excellus Health Plan; BCBS Michigan Mutual Insurance; Wellmark in the upper Midwest and northern Plains; and Dean Health.

Twelve are new to five star ratings this year, that is they didn't have five star status last year: KS Plan Administrators; BCBS of Massachusetts HMO Blue; Aultcare Health Insurance' Physicians Health Choice of Texas; CDPHP Universal Benefits; Optimum Healthcare; Kaiser Foundation HP; Anthem Insurance and BCBS of Massachusetts, BCBS of Rhode Island and BCBS of Vermont; Excellus Health Plan; BCBS of Michigan Mutual Insurance; Wellmark; and Dean Health Insurance.

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Overall, nearly half of all MA-Part D plans earned a rating of four stars or higher. On average, higher star ratings are associated with more experience in the program, CMS said.

Also, organizations that are nonprofit tend to receive higher ratings than those that are for-profit, CMS said. For MA-Part-Ds, approximately 70 percent of the non-profit contracts received four or more stars compared to 39 percent of the for-profit MA-Part-Ds.

Similarly, approximately 63 percent of non-profit prescription drug plans received four or more stars compared to 24 percent of the for-profit PDPs.

Nonprofit organizations also performed better than for-profit organizations last year, CMS said.

The two contracts that identified as low ranking, with 2.5 or fewer stars, were: Phoenix Health Plans, parent organization, Tenet Healthcare; and GHS Managed Health Care Plans, parent organization, Health Care Service Corporation.

Twitter: @SusanJMorse