CMS gives star ratings to help prospective members as well as other companies evaluate the quality of a program that a Health Plan is offering. Health Plans are ranked from 2 stars to 5 stars upon many different factors. Each of the factors are then compiled and a Health Plan is given an overall rating. CMS and the government are trying to incentivize more plans to raise the quality of their service by offering over $3 billion in federal bonus payments to help manage conditions that may be plaguing members. CMS wants Health Plans to offer better benefits and innovative treatments to their members, and this is why they have created these incentives. By taking better care of members, Health Plans can improve their star rating and thus increase the money that they receive.
Increasing a star rating is a great way to gain more members as well as gain more funding. Prospective members are more likely to select a Health Plan with a better star rating, because while they are looking for the best rates, they also expect the best service and benefits. 5-star rated plans are rare – there are only 7 in the country for 2016, but there are many other good plans out there and smart consumers will shop around for the best options. In 2016, the general quality of all Health Plans has risen, so the landscape is more competitive than ever. That is why plans must strive to be better every year if they hope to maintain and grow their membership.