Proposals Related to: Quality bonus program and star ratings
Each year, CMS assigns MA plans a quality rating of one (low) to five (high) stars based on a combination of performance measures. That five-star system was intended to help beneficiaries choose among plan options. In addition, the quality ratings are used as an incentive to reward plans that provide higher quality care. Medicare’s payment system compares MA plan bids to administrative benchmarks that are based on average spending in original Medicare that is adjusted in several ways. One key adjustment is that MA plans with higher star ratings are awarded bonus amounts to their benchmarks. In certain counties, those quality bonus amounts are doubled for plans with high rankings. Additionally, when a plan sponsor bids below the plan’s benchmark, each plan’s star rating affects the amount of its MA rebate (i.e., what proportion of the difference between the plan’s benchmark and bid it can use to lower enrollee premiums or to provide supplemental benefits). Those approaches give plans with higher quality ratings more MA rebate dollars to attract enrollees. However, the Medicare Payment Advisory Commission has found that the MA star-rating system does not effectively promote high-quality care. For example, it measures quality over large and sometimes disparate geographic areas rather than local markets. Proposals in this category would change how quality is measured for MA plans or revise how MA plan payments are affected by quality ratings.
NOTE: Entries with grey backgrounds are Georgetown estimates. Entries with white backgrounds are either descriptive information or analysis made by or for the proposal authors.
| Proposal | Effects on beneficiaries | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Short description | Category | Author | Federal savings (-$) or costs (+$) | Access to plans | Enrollee costs | Supplemental benefits | Part B premiums | Other affected stakeholders | |
Key:
- Federal savings or costs. When available, we provide original estimates from source materials by the proposal author(s) or from the Congressional Budget Office. Authors prepared estimates for some proposals at a time when plan enrollment and payments differ from today, and thus estimates of savings or costs should be interpreted cautiously. When no author’s estimate was available, Georgetown provided an estimate, as indicated by grey highlighting. Click Details for more information about savings or costs for a specific proposal.
Estimates in source materials prepared by the author(s) cover different numbers of years and windows of time. To give website users a consistent sense of magnitude, we categorized proposals by whether its estimate was approximately less than $10 billion over 5 years or greater than or equal to that amount. Thus, in this column,- +$ indicates anticipated costs to the federal government of less than $10 billion over 5 years.
- +$$ indicates anticipated costs of $10 billion or more over 5 years.
- –$ indicates anticipated savings to the federal government of less than $10 billion over 5 years.
- –$$ indicates anticipated savings of $10 billion or more over 5 years.
- We list a question mark for proposals in which the author(s) would need to specify more detail to estimate federal spending.
- Effects on beneficiaries. When available, the estimate was provided by the proposal author(s) within the cited source materials. When no author’s estimate was available, Georgetown provided an estimate, as indicated by grey highlighting. In the four columns under this header,
- Up arrows indicate anticipated greater access to plans, higher costs (premiums and cost sharing) for plan enrollees, more availability of extra benefits, or higher Part B premiums applicable to all beneficiaries.
- Down arrows indicate the reverse effects.
- Combined up and down arrows indicate mixed effects, such as up for some categories of beneficiaries and down for others.
- Categories may also be reported as “minimal or no effect” or “not applicable.”
- We list a question mark for proposals in which the author(s) would need to specify more detail to estimate effects on beneficiaries.
- Click Details for more information about beneficiary effects for a specific proposal.
- Other affected stakeholders. This column reports any stakeholders other than Medicare beneficiaries likely to be affected significantly by the proposal. Click Details for more information about a specific proposal.