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Analysis Finds Nearly Half of Medicare Advantage Enrollees Opt For Lower-Quality Plans

By CQ Staff

April 29, 2010 -- An analysis released Thursday by a Washington health consulting firm found that many Medicare Advantage enrollees are not enrolled in the plans judged highest in quality on the government's website.

Avalere Health looked at the Centers for Medicare and Medicaid Services Part C Report Card for 2010 and compared it to Medicare Advantage enrollment data. The report card features "star" ratings scores for Medicare private plans, with a five being the highest rating possible.

The analysis found that about 38 percent of Medicare Advantage enrollees are signed up for plans rated with 3.5 stars or above and fewer than 1 percent are in five-star plans. About 47 percent are in plans with ratings of three stars or below. The remainder of enrollees are in plans that are not rated because they are too new or don't have enough data for scoring.

Medicare Advantage funding is set to be reduced under the new health care law (PL 111-148) and Avalere experts noted that beginning in 2012, plans' payments will be tied to their quality scores. That may lead plans to focus on improving their scores — for example, they may pay more attention to complaints or customer service, said Bonnie Washington, an Avalere vice president, in a statement.

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