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What type of things is Medicare looking at when rating plans?

Medicare measures plans in many areas, including:

  • Staying healthy. Are members getting the screenings, vaccines and other preventive care needed to help them stay healthy?
  • Managing chronic conditions. How often are members with chronic conditions getting the recommended tests and treatments to manage their conditions?
  • Member experience. How satisfied are members with the health plan and their care?
  • Member complaints. How often do members have problems with the plan? How many members have left the plan?
  • Customer service. How well does the plan handle member calls, questions and concerns?

Plans like SCAN that also provide prescription drug coverage are evaluated in more areas, like whether medications are being prescribed in a way that’s safe and effective.

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