Health Plan Quality Ratings Will Be Available on Nationwide Health Insurance Exchange

Last Updated: Aug 21, 2019

Health-Insurance-OnlineThe Centers for Medicare and Medicaid Services (CMS) has announced that it is expanding consumer access to its health plan Quality Ratings System, making it available on all national health insurance exchanges.

While the star ratings system had previously been available for programs such as Medicare Advantage, the 2020 open enrollment period marks the first time that the ratings system will be offered nationwide through the Health Insurance Marketplace at Healthcare.gov.

The Quality Ratings System uses a five-star ratings system, with five stars representing the highest quality. The overall star rating is based on three categories:

  • Medical Care – How the plan’s network providers manage member health care, including regular screenings and vaccines.
  • Member Experience – How health plan member surveys measure satisfaction with their health care and the ease of getting appointments and services.
  • Plan Administration – How the plan is run, including customer service and access to information.

CMS says the increased access to star ratings is part of its overall goal to provide consumers with the tools to make health care choices.

You can find more information about the Quality Ratings System in this CMS fact sheet. CMS also offers “Results at a Glance” overview for the Quality Rating System for the 2019 Plan Year here.

How Does This Affect Pennsylvania Patients?

Currently, the commonwealth uses the federal Healthcare.gov exchange to offer Affordable Care Act plans. Pennsylvania patients shopping for plans for 2020 will have access to the star ratings system through the federal exchange.

Pennsylvania will soon be moving to its own state-based health insurance exchange. A law signed by Gov. Tom Wolf in June 2019 – Act 42 of 2019 – will enable Pennsylvania to create its own health insurance exchange for Affordable Care Act plans. The state’s new exchange could be available to consumers in time for them to make selections for the 2021 plan year. Read more about Act 42 here.

CMS says that state-based exchanges are generally required to display the overall rating and the star ratings for the three ratings categories. The state exchanges will continue to have flexibility to display additional state or local quality information for their health plans. They will also have some flexibility to customize the display of their health plan quality information and to adjust the display names of the star ratings. 

Open Enrollment Periods

The 2020 open enrollment period for the Health Insurance Marketplace runs from Nov. 1, 2019 to Dec. 15, 2019.

For Medicare Advantage and Medicare Part D prescription drug plans, the yearly enrollment period is Oct. 15, 2019 to Dec. 7, 2019. A second Medicare Advantage open enrollment period – during which beneficiaries can switch from one Medicare Advantage plan to another or from Medicare Advantage to Original Part B Medicare – runs from Jan. 1, 2020 through March 31, 2020.

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