Medicare Five Star Rating: What is it, and How Does it Affect Patient Outcomes?

Medicare uses a five star rating system to assess the quality of Medicare Advantage plans. Unlike traditional Medicare plans, which the government sponsors, private insurance companies offer Medicare Advantage plans. Consequently, to maintain quality control over Medicare plans that private insurers offer, Medicare uses a five star rating system for Medicare Advantage plans. The system is based on how well Medicare Advantage plans perform across five categories. The Medicare five star system also applies to the prescription plan Medicare Part D.

  1. Screening, Vaccines and Tests

Especially as they age, people need regular medical screenings, vaccines and medical tests that check for signs of health problems, prevent health problems from occurring and proactively diagnose existing health problems, respectively. Medicare Advantage plans that perform well across these three sub categories receive a star from the Medicare five star rating system.

  1. Chronic Condition Management

Some conditions are incurable and must be managed throughout the life of the patient. However, some management approaches work better than others. For example, simply providing palliative care for a condition that will last for years often results in less desirable health outcomes than also providing management approaches that treat the root cause of the condition, as well.

  1. Responsiveness and Care

Most of us have heard horror stories about patients having to wait for months to receive important therapies in the face of signs and symptoms that justify the treatments, and accounts of patients who receive poor care after they are finally treated. A Medicare Advantage plan that excels at responsiveness and care avoids these problems, and receives a star for doing so.

  1. Problems With Services

Different Medicare Advantage plans offer different services. When services are rendered in a timely, thorough manner, and in a capacity that effectively treats the condition in question, the plan should receive a star through the Medicare five star rating system. If patients have problems with services, on the other hand, the plan may only receive a maximum of four stars.

  1. Customer Service Quality

Many Medicare Advantage recipients require ongoing customer service to help them take full advantage of insurance benefits and understand changes to the parameters of the plan. Unless the insurer provides this information, among other types, the customer often researches his or her concerns on the internet, which can result in receiving out-of-date or incomplete information.

The Impact on Patient Outcomes
Medicare Advantage plans that perform well across these categories and receive a five star rating are generally viewed as some of the best Medicare Advantage plans available. A major reason why is because they tend to result in better patient outcomes than plans with fewer stars.

Consequently, one of the major benefits of five star plans is their impact on healthcare costs. The better the health outcome of patients, the less money that is spent on prescriptions, additional therapies and procedures, and hospital readmissions — three factors that can have a major impact on whether Medicare Advantage providers raise premiums, and by how much.

How Drug Package Can Help
At Drug Package, we strive to reduce healthcare costs by providing novel medication packaging that, in terms of the Medicare five star rating system, helps improve chronic condition management via prescription medications. Moreover, our unique packaging solutions help improve patient outcomes by increasing medication adherence (a.k.a. medication compliance) across all demographics, with the ability to create special solutions for niche markets.

If you own or manage a pharmacy that is committed to lowering insurance costs by improving patient outcomes with the help of creative medication packaging, call us today at (800) 325-6137, or email us today at We look forward to assisting you!