Marketplace Plans to Receive Star Ratings in 2020

The Centers for Medicare & Medicaid Services (CMS) announced earlier this month that plans sold on the Health Insurance Marketplace (Marketplace) will receive quality ratings using a five-star system (with 5 stars representing the highest quality plan). CMS has been piloting the five-star rating system for plans sold on the Marketplace in Michigan, Montana, New Hampshire, Virginia and Wisconsin, and it will expand it to all plans sold on the Marketplace for the coverage year beginning in 2020. 

The intent of the new quality rating system is to help consumers more easily pick a plan that meets their needs. Plans will be rated based on three categories:

1.  Member experience – Based on surveys of member satisfaction with:

  • Their health care and doctors
  • Ease of getting appointments and services

2.  Medical care – Based on how well the plans’ network providers manage member health care, including:

  • Providing regular screenings, vaccines, and other basic health services
  • Monitoring some conditions

3.  Plan administration – Based on how well the plan is run, including:

  • Customer service
  • Access to needed information
  • Network providers ordering appropriate tests and treatment

All health plans ratings will be calculated the same way, using the same information sources. However, in some cases, a plan sold on the Marketplace may not have a rating. This doesn’t necessarily mean the plan has a  low-quality  rating. The  lack of a star rating may be the  result of the plan being newly offered or having low enrollment. 

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