CMS Adds Health Plan Ratings to ACA Exchanges

The Centers for Medicare & Medicaid Services (CMS) announced on August 15 that health plans offered on health insurance exchanges will be ranked using a five-star quality rating system for the 2020 plan year open enrollment period that begins on November 1, 2019. The ratings will appear on both state-based exchanges and the federal exchange, HealthCare.gov, that were created under the Affordable Care Act (ACA). CMS also released a fact sheet on the ratings system and a summary of 2019 plan year ratings.

Star ratings will cover three major areas. CMS will evaluate plans’ effectiveness in providing medical care, including whether network providers are scheduling regular screenings, vaccinations, and other basic health services for their patients. Plans’ ratings for “member experience” will be based on surveys of patient satisfaction with their providers, including ease of getting appointments. The plan administration category will look at how well the plan is run, including customer service and how easily members can access necessary information. New plans or those with low enrollments might not receive a star rating.

CMS conducted a pilot of the star rating system in Virginia and Wisconsin for the 2017 and 2018 open enrollment periods and added ratings in Michigan, Montana, and New Hampshire for the 2019 plan year. The agency hopes that the nationwide rollout will increase transparency and competition among plans, resulting in better-quality and cost-effective care for consumers.