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CMS Brings Health Plan Quality Ratings to All Exchanges

August 21, 2019

McDermott+Consulting

The Centers for Medicare and Medicaid Services (CMS) will require the display of the five-star Quality Rating System available nationwide for health plans offered on the Health Insurance Exchanges beginning in the 2020 Open Enrollment Period. This is the first time such information is required to be displayed.

Exchange plans are given a rating on a 1 to 5 scale with five-star plans representing the highest quality. The overall star rating is based on medical care, member experience, and plan administration.

CMS conducted a limited pilot displaying star ratings in two states, Virginia and Wisconsin, during the 2017 and 2018 enrollment periods, and expanded the pilot to include three additional states, Michigan, Montana, and New Hampshire, during the 2019 enrollment period.

CMS has indicated that their intent is to improve the consumer experience by increasing the availability of quality information to those enrolling in health plans through the Exchanges.

The 2020 Open Enrollment Period is November 1, 2019 to December 15, 2019.

The Exchange Quality Rating System guidance is available here, and the press release is available here.

For more information on the Exchange Quality Rating System please see this fact sheet.

 


For more information visit the McDermottPlus Payment Innovation Resource Center or contact Sheila Madhani at 202-204-1459 or smadhani@mcdermottplus.com.

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