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The Fundamentals of Medicare Advantage Star Rating Methodology

The Fundamentals of Medicare Advantage Star Rating Methodology

August 10, 2021Kelsey WaddillNo CommentsHealthPayerIntelligenceMedicare ACOs/MSSP

The way to determine the quality of a Medicare Advantage health plan is simple: look at the five-star rating on the Medicare website. However, the Medicare Advantage Star Rating methodology that produces that star indicator is much more complex.

A Medicare Advantage plan is a private payer health plan which the federal government funds and regulates. Medicare Advantage plans are considered Part C of the overall Medicare program. Many Medicare Advantage plans are combined with a Medicare Part D plan— a drug plan—to form a Medicare Advantage-Part D plan.

In a Medicare Advantage plan, private payers receive payments at the contract level from the government to cover Medicare beneficiaries’ health.

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: CMS, Medicare, Medicare Advantage, Medicare Advantage Star Rating, quality measures, quality of care

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