CMS Star Rating Implementation for Insurance Plans

By August 22, 2019 Uncategorized

In a move to drive toward transparency and better quality in the healthcare system, HealthCare.gov has recently announced the State Obamacare exchange websites will begin publishing quality star ratings for insurance plans.

Toward the start of the 2020 plan year, a five-star quality rating system will be implemented similar to Medicare Advantage. The now-nationwide policy will award a number of stars dependent on how enrollees rate their in-network doctors, received care, customer service, and overall experience. All state exchange sites, and HealthCare.gov will display the ratings.

The idea first began in 2017 when the CMS started experimenting with limited pilots in Virginia and Wisconsin. Later, during the 2019 open enrollment period, the pilots rolled out in three additional states.

CMS states the star ratings may not be universally available yet in new or low enrollment plans. Additionally, the Medicare Payment Advisory Commission recommends additional changes.

A statement by the CMS Administrator, Seema Verma states “This addresses our strongly held commitment to equip consumers with the tools they need to find the best choice possible. Increasing transparency and competition drive better quality and cost, with consumers benefiting the most.”

 The FFM certification also states that if at all possible have a written consent from the consumer to work on their behalf as the agent.  These are incremental moves to imitate compliance requirement as in Medicare Advantage providing additional protections for the consumer.  Not sure however, if a full-blown SOA process will allow enough time during the current OE cycle and if implemented, a six-month enrollment period would be necessary.