Quality Ratings Offered in Medicare Enrollment Window

Open enrollment for Medicare starts at the end of next week. This week, the federal government launched its online service to help people make Medicare decisions. This year, ther service offers a little something extra, according to David Sayen, the regional administrator for CMS.

“This enrollment period is different,” Sayen said. “For the first time, we’re rewarding quality.”

Medicare Advantage plans now will be rated for quality of care. Part D prescription drug plans will continue to be rated for quality.

There’s one other important change in the process, Sayen said: “This year it’s a single open enrollment season that starts earlier and ends earlier.”

Open enrollment starts Oct. 15 and goes till Dec. 7. Changes made during that period become effective Jan. 1. The biggest change in the Medicare evaluation process is the quality scoring system, Sayen said.

“Plans are paid based on a score for each beneficiary, so those with two or three stars, those plans who score higher will get payment for that,” Sayen said. “Plans that reach the full five-star status, those are sort of like a queen on a chessboard.”

If Medicare patients don’t want to use the online evaluation tool, there are many other ways to see if their health needs fit their coverage, Sayen said.

“Everybody gets a Medicare handbook, to show all of the plans available,” he said. “There’s an 800 number where they can call the operators and make a choice, and they can help calculate the plans that you’re likely to need based on your health status. Or there’s someone who can actually be scheduled to go out to someone’s house, and go through their shoebox full of receipts and see what works for them.”

The drug and health plan data for Medicare went live on Saturday, two full weeks before open enrollment officially begins, to enable people to match health needs to coverage ahead of time. Benefits in 2012 remain consistent with those offered in 2011, Sayen said.

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