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More Medicare Private Plans Reaching for the Stars, CMS Reports

By Jane Norman, CQ HealthBeat Associate Editor

October 12, 2012 --Officials with the Centers for Medicare and Medicaid Services recently said that additional highly rated Medicare Advantage and prescription drug plans will be available to enrollees when open enrollment for Medicare begins.

Jonathan Blum, Medicare director, said that in 2012, people enrolled in Medicare had access to 106 four- or five-star Medicare Advantage plans; in 2013, there will be 127 insurance plans to choose from. The plans are private alternatives to fee-for-service Medicare and enrollment in them has been growing steadily.

Also in 2012, just 28 percent of enrollees were signed up for a four- or five-star plan, Blum said. In 2013, it's estimated that should increase to 37 percent, he said.

Stand-alone Medicare prescription drug plans that are deemed to be the top-rated also will be more widely available, said Blum. In 2012, there were 13 and in 2013 there will 26.

In 2012, just 9 percent of enrollees were enrolled in those highly rated Part D plans, but that is projected to double to 18 percent in 2013.

Overall, 51 percent of all beneficiaries have access to a four-star or five-star Medicare Advantage plan and that percentage will rise to 68 percent in 2013, he said. Virtually every beneficiary will have access to a four- or five-star prescription drug plan, he said.

Medicare Advantage also came up during last week's debate between Vice President Biden and Republican vice presidential nominee Paul Ryan. When Ryan said that 7.4 million seniors are projected to lose their Medicare Advantage plans, Biden responded: "That didn't happen." And, he said, "More people signed up."

The trend in Medicare Advantage indeed has been toward increased enrollment numbers, although CMS actuaries earlier had projected that participation would drop because of reductions in payments mandated under the health care law (PL 111-148, PL 111-152). Insurers also have warned that enrollees may begin shying away from Medicare Advantage as cuts are implemented in years to come.

"To our minds this is very good news—we are seeing tremendous quality jumps," Blum said of the increased quality effort. "We are using multiple tools to achieve this quality improvement, financial incentives and also non-financial incentives."

For example, beneficiaries who are in low performing plans—ones that score below three stars for three consecutive years—will get letters from CMS encouraging them to switch, Blum said. Low-performing plans are highlighted on the Medicare website, too.

Medicare officials have been working hard to steer seniors toward plans that receive either four or five stars on a one- to five-star scale, with five representing the highest level a plan can achieve. It's an effort that also drawn criticism and controversy in connection with an $8 billion CMS demonstration program to award bonuses to plans.

Blum said four- and five-star plans focus on health needs of enrollees, process claims quickly, hear appeal requests in a timely manner and administer drug benefits in line with federal rules. "We have great confidence that those plans that achieve four or five star ratings best serve their beneficiaries," he said.

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