Medicare Star Rating

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What is the Medicare Star Rating?

Every year the Centers for Medicare and Medicaid Services (CMS) complete a performance evaluation of all health plans offering Medicare Advantage coverage. CMS gives the plans a score between 1 and 5 Stars, based on the areas evaluated. Some areas evaluated by CMS for these ratings include:

  • How well our members evaluate the health plan customer and care services
  • How well our doctors detect diseases and maintain our members healthy
  • How well the plan helps members with their recommended prescription drugs

This assessment is divided into health services and drug services, obtaining an overall result between the two. This score can vary each year and depends on a large extent of the members’ compliance with their care and medical treatment.

How can I help my plan achieve the Stars?

An important part of the Star Rating is the fulfillment of the measures below. We advise you to talk to you doctor in order to identify which of these tests apply to you. Your doctor can help you find alternatives to manage your health conditions.

What are the recommended preventive tests?

Preventive tests are performed in order to prevent any health complications or changes in your current health conditions. Complying with your preventive tests will help you stay healthy and achieve a better quality of life.

Test Description Who should have this test performed? Frequency
Cholesterol LDL Cholesterol blood test All adults between 18 and 75 yrs. Once a year
Breast cancer screening Mammogram All women between the ages of 50 and 74. Once every two years.
Colorectal cancer screening Could be one of the following:
-Blood Occult Test
-Colonoscopy
-Sigmoidoscopy
All adults between 50 and 75 yrs. Depending on the test once a year to one every 10 yrs.
Glycated Hemoglobin (A1c) Blood Sugar levels lab test All Diabetics between the ages of 18 and 74 yrs. Every six months or once a year.
Flu vaccine Vaccine to prevent flu/Influenza. All adults over the age of 50 yrs. Once a year.
Eye exam for retinopathy Prevention Eye exam for diabetics. All Diabetics between the ages of 18 and 74 yrs. Once a year.
Bone density test Preventive tests for the early detection of osteoporosis. All women over the age of 65 yrs. Once a year.
Kidney diseases preventive test Urine test to prevent kidney diseases. All Diabetics between the ages of 18 and 74 yrs. Once a year.

In addition to these tests, remember to talk to your doctor about the following topics:

  • Bladder Control
  • Fall Prevention
  • Recommendations for Physical Activity
  • Nutrition
  • General Care for Your Physical and Mental Health
  • Advance Directives

Last update: 10/01/2016

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