Americans planning to shop for health insurance on the Affordable Care Act's health insurance exchanges this fall will have a new way to compare the quality of plans being offered—star ratings.
Under the now-nationwide mandate, set to start for the 2020 plan year, health-care plans on the exchange will be rated using a five-star quality rating system similar to what exists for Medicare Advantage, with a star rating of five being the best, as it is on Yelp and Amazon.
HealthCare.gov and all the state exchange sites will post the ratings, which will be based on 38 critical quantitative and qualitative measures of how well a health-care plan has performed. Ten of the measures are based on how enrollees rate their plan, their in-network doctors, the care received, customer service and overall experience.
"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, administrator for the Centers for Medicare and Medicaid Services (CMS), the agency within the Department of Health and Human Services that administers health-care programs.
The star ratings will be available to consumers during the ACA open enrollment period, which runs from November 1 through December 15. The plan choice consumers make during that period goes into effect in January 2020.
The star rating system is designed to measure how well plans perform and scores them in three categories: member experience, medical care and plan administration, said CMS in a statement.
The purpose of the rating system is to help consumers make informed decisions, to facilitate oversight of health plans and to provide actionable information to health plans so they can improve the quality of their services, the agency added.
The ratings are based on factors that include how enrollees rate the doctors in a plan's network, how well the plan is run and how easy it is to get an appointment, information, needed tests and treatments.
“This addresses our strongly held commitment to equip consumers with the tools they need to find the best choice possible,” Verma said. “Increasing transparency and competition drive better quality and cost, with consumers benefiting the most.”
The data collection and rating system are also designed to provide a feedback loop to the health-care plans themselves so they can make necessary improvements.