Tufts Health Plan Offers Best 2018 Star Ratings Transparency

By Alan Mittermaier

Congratulations Tufts Health Plan and its Medicare Preferred website upon setting the transparency standard that every Medicare Advantage plan website would be well-served to follow.  Tufts Medicare Preferred is the only website (among 160 websites surveyed) to voluntarily disclose its 2018 Star Ratings for each of the health plan rating categories (5) and the drug plan rating categories (4) that comprise the overall ratings for both (see below).  The additional disclosure increases the likelihood that plan members and prospects will make informed choices when weighing enrollment choices.

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Tufts Medicare HMO Plans Star Ratings

Rating Details

Health Plan Star Ratings

For plans covering health services, the overall score for quality of those services covers 32 different topics in 5 categories:

Staying Healthy (screenings, tests, and vaccines): ★★★★★

Includes how often members got various screening tests, vaccines, and other check-ups that help them stay healthy.

Managing Chronic (long-term) Conditions: ★★★★★

Includes how often members with different conditions received certain tests and treatments to help them manage their conditions.

Member Experience with Health Plan: ★★★★★

Includes how members rated their satisfaction with the plan.

Member Complaints, Problems Getting Services, and Improvements in the Health Plan’s Performance: ★★★★★

Includes how often Medicare found problems with the plan and how often members filed complaints against the plan and chose to leave the plan. Includes how much the plan’s performance has improved (if at all) over the last two years.

Health Plan Customer Service: ★★★★★

Includes how well the plan handles calls from members, makes decisions about member appeals for health coverage, and handles new enrollment requests in a timely way.

Prescription Drug Plan Star Ratings

For plans covering drug services, the overall score for quality of those services covers 15 different topics in 4 categories:

Drug Plan Customer Service: ★★★★

Includes how well the plan handles calls from members, makes decisions about member appeals for drug coverage, and handles new enrollment requests in a timely way.

Member Complaints, Problems Getting Services and Improvements in the Drug Plan’s Performance: ★★★★★

Includes how often Medicare found problems with the plan and how often members filed complaints against the plan and choose to leave the plan. Includes how much the plan’s performance has improved (if at all) over the last two years.

Member Experience with the Drug Plan: ★★★★★

Includes how members rated their satisfaction with the plan.

Drug Safety and Accuracy of Drug Pricing: ★★★★

Includes how well the plan provides accurate pricing information for the Medicare website. Includes information on how often members with certain medical conditions get prescription drugs that are considered safer and clinically recommended for their condition. Includes information on whether members are taking certain medications as directed.

For plans covering both medical and drug services, the overall score for quality of those services covers all of the 9 categories listed above.

Where Do the Ratings Come From?

Medicare rates all health and prescription drug plans every year by assigning a rating of 1 to 5 stars to each plan. Star ratings can be used to quickly identify how well a plan works with their members. The rating is based on quality and performance in a number of categories including:

  • Member Satisfaction with the Plan
    How well the members rate the quality of the plan.
  • Customer Service
    Our ability to provide customer service that helps members get answers to their questions quickly.
  • Getting Screening and Checkups to Stay Healthy
    How well we help members get preventive screenings and check- ups in order to find medical conditions early when they are easier to treat.
  • Managing Chronic Conditions
    How well we help members manage chronic conditions such as diabetes by making sure they get the help they need to stay healthy.
  • Number of Complaints
    The number of complaints we receive from members about their plan. A good rating in this category means we received a low number of complaints.

*Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. For more information on plan ratings, go to www.medicare.gov.

 

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