CMS improves quality rating to help consumers assess insurance exchanges

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Healthcare consumers looking for health insurance coverage under federal insurance exchanges for 2020 will get more assistance in picking their selection.

Some existing government insurance websites such as Nursing Home Compare and Medicare Advantage have been offering a five-star quality rating system to ease selection.

Now, the Centers for Medicare and Medicaid Services is requiring nationwide display of the rating systems for all health plans offered on the health insurance exchanges.

“Knowledge is powerful and for the first time, consumers will have access to meaningful, simple-to-use information to compare the quality, along with the price, of health plans on Exchange websites, including,” says CMS Administrator Seema Verma.

Under the rating systems, health plans are given quality rating on a 1 to 5 scale, with 5 being the highest quality. The ratings are based on how other enrollees rate doctors in a plan’s network and type of care they receive, how the providers in a plan’s network coordinate care with enrollees and other doctors, customer service and availability of information.

If health plans are new or have low enrollment, star ratings may not be available in all areas of the nation, but the lack of a star rating does not mean a plan has a low quality rating, according to CMS.

Overall ratings are based on such factors as how plan manage member healthcare and offer regular screenings, vaccines, basic health services, ease of getting appointments and services, and providers ordering appropriate tests and treatment.

Nationwide star ratings come following pilot programs in Michigan, Montana, New Hampshire, Virginia and Wisconsin.

CMS now is posting ratings and quality measure level data from the 2019 plan year in a Public Use File, available to consumers, researchers, agents, brokers, states, health issuers and consumer groups so these entities can use and analyze the data. Ratings for the 2020 plan year will be released closer to the Open Enrollment period that starts on November 1 and ends December 15.

More information is available here.

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