Tufts Medicare Preferred Sets Benchmark for 2015 Star Ratings Transparency

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 168 websites surveyed) to voluntarily disclose its 2015 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 – Health Plan Star Ratings

Overall Score: ✰✰✰✰✰

For plans covering health services, the overall score for quality of those services covers 45 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.

Tufts Medicare HMO Plans – Prescription Drug Plan Star Ratings

Overall Score: ✰✰✰✰½

For plans covering drug services, the overall score for quality of those services covers 18 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 Peformance: ✰✰✰✰✰

    • 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 & drug services, the overall score for quality of those services covers all of the 9 categories listed above.

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