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December 03, 2021

MA-PD Plans’ Star Ratings Increase Results in Increased Payments

There was a sharp increase in the star ratings of Medicare Advantage Prescription Drug plans for 2022. These MA-PD Plans’ reimbursement rates are partially tied to "quality metrics" for Medicare Advantage that are expressed as Star Ratings. These quality measures more closely resemble a JD Power survey than real "quality based on outcomes and reduced costs." However, the higher the star rating - the more CMS pays for the lives covered under Medicare. Based on the “impact of Covid,” CMS waived or eliminated many of the metrics, which resulted in a significant increase in the number of MA-PD plans scoring 4 or higher. This results in an increase in the payments to MA-PD plans next year. A number of plans actually improved, but many enjoyed the benefit of the lowered bar. If the metrics for 2023 revert back to pre-pandemic metrics (or are strengthened), star ratings for 2023 can be expected to be lower than in 2022.