En español | Americans planning to shop for health insurance on the Affordable Care Act's (ACA) health insurance exchanges this fall will have a new way to compare the quality of the plans being offered. For the first time, the federal government will display its five-star quality rating system that includes how well patients on the plans say they work.
The Centers for Medicare and Medicaid Services’ (CMS) star ratings have been available for years for Medicare's private insurance products — Medicare Advantage plans and the Part D prescription drug plans. CMS has been collecting similar data for Affordable Care Act plans since 2016 and has tested out making the ratings available in a limited number of states.
"Knowledge is power, and for the first time, consumers will have access to meaningful, simple-to-use information to compare the quality, along with the price, of health plans on exchange websites, including HealthCare.gov,” said Seema Verma, CMS administrator. The ACA open enrollment period begins Nov. 1 and lasts through Dec. 15. The choices consumers make during that period will take effect in January.
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Under the five-star Quality Rating System, plans on the exchanges have a rating of 1 to 5, with 5 representing the highest quality. The ratings are divided into three categories: quality of medical care, the member experience and plan administration.
The ratings are based on such factors as how enrollees rate the doctors in the plan's network, the care they've received and how well the plan is run. Members were surveyed and asked about the quality of customer service, including how easy it is to get an appointment and the availability of information, needed tests and treatments.
CMS officials caution that in some cases, star ratings will not be available for all plans, particularly those that are new or have a small number of enrollees.
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