Date

Fact Sheets

2023 Medicare Advantage and Part D Star Ratings

Note: The information included in this Fact Sheet is based on the 2023 Star Ratings published on the Medicare Plan Finder on October 6, 2022. For details on the Medicare Advantage (MA) and Part D Star Ratings, please refer to the 2023 Part C & D Star Ratings Technical Notes available at http://go.cms.gov/partcanddstarratings.

Introduction

The Centers for Medicare & Medicaid Services (CMS) publishes the Medicare Advantage (Medicare Part C) and Medicare Part D Star Ratings each year to measure the quality of health and drug services received by consumers enrolled in Medicare Advantage (MA) and Prescription Drug Plans (PDPs or Part D plans). The Star Ratings system helps Medicare consumers compare the quality of Medicare health and drug plans being offered so they are empowered to make the best health care decisions for them. An important component of this effort is to provide Medicare consumers and their caregivers with meaningful information about quality alongside information about benefits and costs to assist them in being informed and active health care consumers.

Highlights of Contract Performance in 2023 Star Ratings[1]

Changes in the Methodology for the 2023 Star Ratings

Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures; MA-only contracts (without prescription drug coverage, or Part D) are rated on up to 28 measures; and stand-alone Part D (PDP) contracts are rated on up to 12 measures. As finalized in previous rulemaking, the updated Controlling Blood Pressure (Part C) measure was re-specified and was transitioned off the display page and into the 2023 Star Ratings as a new measure.[2] This measure has a weight of 1 for the first year (2023 Star Ratings) and a weight of 3 thereafter. Starting with the 2023 Star Ratings, the Rheumatoid Arthritis Management (Part C) measure was retired and the updated Statin Use in Persons with Diabetes (Part D) measure weighting category was implemented (changed from an intermediate outcome measure with a weight of 3 to a process measure with a weight of 1).[3]

Guardrails[4] were introduced in the 2023 Star Ratings for all measures that have been in the Part C and D Star Rating program for more than three years except the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and the Part C and Part D improvement measures. Guardrails are bi-directional caps that restrict upward and downward movement of a measure’s cut points for the current year’s measure-level Star Ratings compared to the prior year’s measure-threshold specific cut points. The weight of patient experience/complaints and access measures increased from 2 to 4 for the 2023 Star Ratings.[5]

For the 2023 Star Ratings, the only adjustments for the impact of the COVID-19 public health emergency (PHE) are the measure-level adjustments for three Healthcare Effectiveness Data and Information Set (HEDIS) measures derived from the 2021 Health Outcomes Survey (HOS).[6] The 2022 Star Ratings included measure-level adjustments for other (non-HOS) measures under the extreme and uncontrollable circumstances rules as a result of the COVID-19 PHE. For example, for most measures, if a measure-level Star Rating was lower for the 2022 Star Ratings relative to the prior year, the measure-level Star Rating (and numeric score) reverted to the rating (and numeric score) from the 2021 Star Ratings (see 42 C.F.R. §§ 422.166(i), 423.186(i)).

Measure Level Changes

Data from the 2019 through 2021 measurement periods help us understand how the PHE impacted the care delivery system. Tables 1-3 below include information at the national level about the overall change in contract-level average measure scores (i.e., unweighted by the size of the contract) from the 2021 to 2023 Star Ratings (for all measures without a substantive specification change across the three years). The scores are shown prior to any adjustments under the extreme and uncontrollable circumstances rules; thus, they reflect actual performance during the measurement period. The measures in Tables 1-3 are shown in order of which have the largest increases to the largest decreases in scores from the 2021 to 2022 Star Ratings. The arrows indicate whether the change in scores is positive or negative from the 2022 to 2023 Star Ratings. The last column of these tables highlights more substantive changes of 2 percentage points or more in either direction.

  • Part C measures are displayed in Table 1 for MA contracts. Scores for most measures for the 2023 Star Ratings show a negligible change in both directions compared to data from the prior year at the national level. The Diabetes Care — Blood Sugar Controlled and Osteoporosis Management in Women Who Had a Fracture measures show larger increases. Two of the HEDIS measures collected through HOS (Improving Bladder Control and Reducing the Risk of Falling), the measure Call Center — Foreign Language Interpreter and TTY Availability, and the measure Members Choosing to Leave the Plan show larger declines.
  • Part D measures are displayed in Tables 2 and 3 for MA-PD and PDP contracts, respectively. Most measure score changes between the 2022 and 2023 Star Ratings were small overall in both directions.   

Table 1: Changes in Part C Measure Scores from 2021 to 2023 Star Ratings for MA Contracts

Measure

2021 National Average

2022 National Average

2023 National Average

Change in Average from 2022 to 2023

Increase / Decrease in Performance from 2022 to 2023

 Change from 2022 to 2023

 > 2 points

Special Needs Plan (SNP) Care Management

69.86

72.74

72.75

0.01

 

Statin Therapy for Patients with Cardiovascular Disease*

80.86

83.32

84.50

1.18

 

Medication Reconciliation Post-Discharge*

64.53

66.93

68.04

1.11

 

Improving Bladder Control

43.75

45.46

43.42

-2.04

> 2 points

Reviewing Appeals Decisions

92.26

93.94

94.80

0.86

 

Rating of Health Plan*

86.28

87.41

86.77

-0.64

 

Rating of Health Care Quality*

86.18

87.14

86.31

-0.83

 

Getting Appointments and Care Quickly*

78.14

78.96

77.28

-1.68

 

Annual Flu Vaccine*

72.64

73.07

72.34

-0.73

 

Customer Service*

90.55

90.87

90.18

-0.69

 

Care Coordination*

85.99

86.21

85.62

-0.59

 

Complaints about the Plan**

0.19

0.21

0.30

0.09

 

Getting Needed Care*

83.13

83.01

81.21

-1.80

 

Plan Makes Timely Decisions about Appeals

95.86

94.98

94.04

-0.94

 

Reducing the Risk of Falling

56.30

55.30

53.28

-2.02

> 2 points

Diabetes Care – Kidney Disease Monitoring*

95.64

94.43

95.15

0.72

 

Call Center – Foreign Language Interpreter and TTY Availability

93.30

92.09

89.87

-2.22

> 2 points

Colorectal Cancer Screening*

74.23

72.87

72.33

-0.54

 

Monitoring Physical Activity

50.94

49.52

48.47

-1.05

 

Members Choosing to Leave the Plan**

13.16

14.68

17.15

2.47

> 2 points

Care for Older Adults – Pain Assessment*

92.86

90.37

89.40

-0.97

 

Care for Older Adults – Medication Review*

92.42

89.78

89.83

0.05

 

Breast Cancer Screening*

74.73

71.17

70.43

-0.74

 

Diabetes Care – Blood Sugar Controlled*

80.26

76.35

78.92

2.57

> 2 points

Diabetes Care – Eye Exam*

75.00

70.51

72.30

1.79

 

Osteoporosis Management in Women who had a Fracture*

48.03

39.64

45.00

5.36

> 2 points

* Measures from HEDIS and CAHPS used data from the 2020 Star Ratings (collected in 2019 and unaffected by the COVID-19 PHE).

 **For Complaints about the Plan and Members Choosing to Leave the Plan a lower score is better. An increase in scores for these 2 measures is a decrease in performance. The Complaints about the Plan measure is a rate of complaints about the plan per 1,000 members.

Table 2: Changes in Part D Measure Scores from 2021 to 2023 Star Ratings for MA-PD Contracts

Measure

2021 National Average

2022 National Average

2023 National Average

Change in Average from 2022 to 2023

Increase/ Decrease in Performance from 2022 to 2023

 Change from 2022 to 2023

> 2 points

MTM Program Completion Rate for CMR

76.89

83.35

82.64

-0.71

 

Medication Adherence for Cholesterol (Statins)

82.35

86.24

86.05

-0.19

 

Medication Adherence for Diabetes Medications

82.61

86.03

85.75

-0.28

 

Statin Use in Persons with Diabetes

80.25

82.86

84.84

1.98

 

Medication Adherence for Hypertension (RAS antagonists)

84.58

87.04

87.20

0.16

 

Rating of Drug Plan*

85.05

86.43

86.26

-0.17

 

Getting Needed Prescription Drugs*

90.06

91.05

90.26

-0.79

 

Complaints about the Plan**

0.19

0.21

0.32

0.11

 

Call Center – Foreign Language Interpreter and TTY Availability

91.74

91.02

89.66

-1.36

 

Members Choosing to Leave the Plan**

13.16

14.68

17.54

2.86

> 2 points

* Measures from CAHPS used data from the 2020 Star Ratings (collected in 2019 and unaffected by the COVID-19 PHE).

**For Complaints about the Plan and Members Choosing to Leave the Plan a lower score is better. An increase in scores for these 2 measures is a decrease in performance. The Complaints about the Plan measure is a rate of complaints about the plan per 1,000 members.

Table 3: Changes in Part D Measure Scores from 2021 to 2023 Star Ratings for PDP Contracts

Measure

2021 National Average

2022 National Average

2023 National Average

Change in Average from 2022 to 2023

Increase/ Decrease in Performance from 2022 to 2023

 Change from 2022 to 2023

> 2 points

MTM Program Completion Rate for CMR

44.54

53.74

53.47

-0.27

 

Medication Adherence for Cholesterol (Statins)

84.32

87.08

87.24

0.16

 

Medication Adherence for Diabetes Medications

84.65

86.68

86.41

-0.27

 

Medication Adherence for Hypertension (RAS antagonists)

86.62

88.45

88.68

0.23

 

Statin Use in Persons with Diabetes

78.73

80.34

82.25

1.91

 

Getting Needed Prescription Drugs*

89.97

90.56

89.55

-1.01

 

Rating of Drug Plan*

83.61

84.15

82.53

-1.62

 

Complaints about the Plan**

0.04

0.06

0.08

0.02

 

Members Choosing to Leave the Plan**

9.71

10.65

10.98

0.33

 

Call Center – Foreign Language Interpreter and TTY Availability

92.43

88.71

89.45

0.74

 

* Measures from CAHPS used data from the 2020 Star Ratings (collected in 2019 and unaffected by the COVID-19 PHE).

**For Complaints about the Plan and Members Choosing to Leave the Plan a lower score is better. An increase in scores for these 2 measures is a decrease in performance. The Complaints about the Plan measure is a rate of complaints about the plan per 1,000 members.

Rating Distribution

The last row in Table 4 shows the trend in the average overall Star Ratings weighted by enrollment for MA-PDs from 2020 to 2023, after any adjustments for extreme and uncontrollable circumstances. The change in distribution from 2022 to 2023 Star Ratings is influenced by changes in measure scores, in both positive and negative directions, and the unusual circumstance of nearly all contracts qualifying for the regulatory adjustment for extreme and uncontrollable circumstances for the 2022 Star Ratings for most measures, resulting in higher than normal 2022 Star Ratings distributions.

  • Approximately 51% of MA-PDs (260 contracts) that will be offered in 2023 earned 4 stars or higher for their 2023 overall rating.
  • Weighted by enrollment, approximately 72% of MA-PD enrollees are currently in contracts that will have 4 or more stars in 2023.

Table 4: 2020 - 2023 Overall Star Rating Distribution for MA-PD Contracts

Overall Rating

2020

2021

2022

2023

# of Contracts

%

Weighted by Enrollment

# of Contracts

%

Weighted by Enrollment

# of Contracts

%

Weighted by Enrollment

# of Contracts

%

Weighted by Enrollment

5 stars

20

4.99

10.96

21

5.25

9.15

74

15.71

26.59

57

11.24

21.87

4.5 stars

72

17.96

31.41

63

15.75

21.92

96

20.38

33.21

67

13.21

25.92

4 stars

118

29.43

38.82

110

27.50

45.76

152

32.27

29.87

136

26.82

24.26

3.5 stars

131

32.67

15.82

141

35.25

18.97

122

25.90

8.49

116

22.88

18.71

3 stars

55

13.72

2.93

61

15.25

4.14

25

5.31

1.80

90

17.75

6.73

2.5 stars

4

1.00

0.05

4

1.00

0.06

2

0.42

0.03

37

7.30

2.39

2 stars

1

0.25

0.02

0

0

0

0

0

0

4

0.79

0.12

Total Rated Contracts

401

100

 

400

100

 

471

100

 

507

100

 

Average Star Rating*

4.16

4.06

4.37

4.15

* The average Star Rating is weighted by enrollment.

The last row in Table 5 shows the trend in the average Part D Ratings weighted by enrollment for stand-alone PDPs from 2020 to 2023 after any adjustments for extreme and uncontrollable circumstances. 

  • Approximately 31% of PDPs (16 contracts) that will be active in 2023 received 4 or more stars for their 2023 Part D Rating.
  • Weighted by enrollment, about 9% of PDP enrollees are in contracts with 4 or more stars.

Table 5: 2020 - 2023 Part D Rating Distribution for PDPs

Part D Rating

2020

2021

2022

2023

# of Contracts

%

Weighted by Enrollment

# of Contracts

%

Weighted by Enrollment

# of Contracts

%

Weighted by Enrollment

# of Contracts

%

Weighted by Enrollment

5 stars

2

3.70

0.76

5

9.09

0.13

10

18.52

0.93

2

3.85

0.06

4.5 stars

7

12.96

1.78

7

12.73

2.38

5

9.26

4.74

7

13.46

0.90

4 stars

7

12.96

25.04

11

20.00

14.13

14

25.93

36.21

7

13.46

7.89

3.5 stars

21

38.89

42.12

19

34.55

81.24

20

37.04

52.84

11

21.15

36.89

3 stars

14

25.93

29.45

9

16.36

1.01

3

5.56

3.84

16

30.77

49.10

2.5 stars

3

5.56

0.84

4

7.27

1.10

2

3.70

1.44

4

7.69

3.18

2 stars

0

0

0

0

0

0

0

0

0

4

7.69

0.58

1.5 stars

0

0

0

0

0

0

0

0

0

1

1.92

1.39

Total Rated Contracts

54

100

 

55

100

 

54

100

 

52

100

 

Average Star Rating*

3.50

3.58

3.70

3.25

5-Star Contracts

A total of 62 contracts are highlighted on the Medicare Plan Finder with a high performing icon[7] indicating they earned 5 stars; 57 are MA-PD contracts (Table A1 in Appendix), three are 1876 Cost Contracts (Table A2 in Appendix), and two are PDPs (Table A3 in Appendix). For 2023, 11 contracts receiving the high performing icon did not receive it in 2022.

Consistently Low Performers

There is one contract identified on the Medicare Plan Finder with a low performing icon[8] for 2023 for consistently low quality ratings. Last year, no contracts received this warning.

Tax Status and Performance

Organizations that are non-profit more frequently earn higher ratings than organizations that are for-profit. For MA-PDs, approximately 72% of the non-profit contracts received 4 or more stars compared to 43% of the for-profit MA-PDs. Similarly, for PDPs approximately 42% of non-profit PDPs received 4 or more stars compared to 25% of the for-profit PDPs. 

Below is the ratings distribution by tax status for MA-PD (Table 6) and PDP (Table 7) contracts after any adjustments for extreme and uncontrollable circumstances.

Table 6: Distribution of 2023 Overall Star Ratings for For-profit and Non-profit MA-PDs

2023 Overall Rating

Count

For-Profit

% For-Profit

Weighted By Enrollment For-Profit

Count Non-Profit

% Non-Profit

Weighted By Enrollment Non-Profit

5 stars

25

6.98

15.39

32

21.48

43.15

4.5 stars

39

10.89

24.55

28

18.79

30.42

4 stars

89

24.86

27.27

47

31.54

14.38

3.5 stars

89

24.86

21.90

27

18.12

8.23

3 stars

77

21.51

7.69

13

8.72

3.57

2.5 stars

35

9.78

3.04

2

1.34

0.26

2 stars

4

1.12

0.15

0

0

0

Total Rated Contracts

358

 

 

149

 

 

Table 7: Distribution of 2023 Part D Ratings for For-profit and Non-profit PDPs

2023 Part D Rating

Count

For-Profit

% For-Profit

Weighted By Enrollment For-Profit

Count

Non-Profit

% Non-Profit

Weighted By Enrollment Non-Profit

5 stars

0

0

0

2

10.53

2.17

4.5 stars

4

12.50

0.47

3

15.79

17.31

4 stars

4

12.50

6.95

3

15.79

45.54

3.5 stars

8

25.00

37.34

2

10.53

1.69

3 stars

8

25.00

50.00

8

42.11

29.70

2.5 stars

4

12.50

3.29

0

0

0

2 stars

3

9.38

0.50

1

5.26

3.58

1.5 stars

1

3.13

1.44

0

0

0

Total Rated Contracts

32

 

 

19

 

 

Length of Time in Program and Performance

Generally, higher overall Star Ratings are associated with contracts that have more experience in the MA program. MA-PDs with 10 or more years in the program are more likely to have 4 or more stars compared to contracts with fewer than five years in the program. For PDPs, the relationship is similar in that PDPs with 10 or more years in the program do better in the Star Ratings relative to contracts with less experience. The tables below show the distribution of ratings by the number of years in the program (MA-PDs are shown in Table 8 and PDPs in Table 9 after adjustments for extreme and uncontrollable circumstances).

Table 8: Distribution of 2023 Overall Star Ratings by Length of Time in Program for MA-PDs

2023 Overall Rating

Number of Contracts with less than 5 Years

% Less than 5 Years

Number of Contracts with 5 years to Less than 10 Years

% 5 Years to Less than 10 Years

Number of Contracts with 10 or More Years

% 10 or More Years

5 stars

8

4.94

8

10.39

41

15.30

4.5 stars

14

8.64

3

3.90

50

18.66

4 stars

41

25.31

27

35.06

68

25.37

3.5 stars

38

23.46

22

28.57

56

20.90

3 stars

35

21.60

14

18.18

41

15.30

2.5 stars

22

13.58

3

3.90

12

4.48

2 stars

4

2.47

0

0

0

0

Total Rated Contracts

162

 

77

 

268

 

Table 9: Distribution of 2023 Part D Ratings by Length of Time in Program for PDPs

2023 Part D Rating

Number of Contracts with less than 5 Years

% Less than 5 Years

Number of Contracts with 5 years to Less than 10 Years

% 5 Years to Less than 10 Years

Number of Contracts with 10 or More Years

% 10 or More Years

5 stars

0

0

1

20.00

1

2.38

4.5 stars

0

0

2

40.00

5

11.90

4 stars

0

0

0

0

7

16.67

3.5 stars

1

20.00

1

20.00

9

21.43

3 stars

0

0

1

20.00

15

35.71

2.5 stars

0

0

0

0

4

9.52

2 stars

3

60.00

0

0

1

2.38

1.5 stars

1

20.00

0

0

0

0

Total Rated Contracts

5

 

5

 

42

 

Average Star Rating for Each Measure

Below we list the average Star Ratings for 2021, 2022, and 2023 Part C and D measures (Tables 10, 11, and 12) using all measure scores for contracts that are publicly reported in a given year. All Star Ratings referenced in Tables 10, 11, and 12 are after the adjustments to address concerns about collecting CAHPS and HEDIS data for the 2021 Star Ratings, regulatory adjustments for extreme and uncontrollable circumstances triggered by the COVID-19 PHE for the 2023 Star Ratings (for non-HOS measures), and the regulatory disaster adjustments for extreme and uncontrollable circumstances triggered by the COVID-19 PHE for HOS measures, and other qualifying extreme and uncontrollable circumstances,[9] for the 2021 performance period have been applied. Please note that Star Rating measure averages (means) do not always reflect performance changes, as measure-level cut points change to reflect significant changes in industry performance and distribution of scores.[10]

Table 10: 2021 - 2023 Average Star Rating by Part C Measure

Measure

2021 Average Star

2022 Average Star

2023 Average Star

Breast Cancer Screening

3.5

3.9

3.7

Colorectal Cancer Screening

3.9

3.9

3.8

Annual Flu Vaccine

3.2

3.4

3.2

Monitoring Physical Activity

3.5

3.1

3.2

Special Needs Plan (SNP) Care Management

3.4

3.6

3.3

Care for Older Adults – Medication Review

4.3

4.4

4.4

Care for Older Adults – Pain Assessment

4.5

4.4

4.3

Osteoporosis Management in Women who had a Fracture

3.1

3.1

2.6

Diabetes Care – Eye Exam

3.8

3.8

3.7

Diabetes Care – Kidney Disease Monitoring

4.2

4.2

3.9

Diabetes Care – Blood Sugar Controlled

4.2

4.3

4.1

Rheumatoid Arthritis Management

3.6

3.7

NA

Controlling Blood Pressure

NA

NA

3.5

Reducing the Risk of Falling

3.0

2.5

2.9

Improving Bladder Control

3.2

2.7

3.3

Medication Reconciliation Post-Discharge

3.0

3.5

3.4

Statin Therapy for Patients with Cardiovascular Disease

3.1

3.5

3.5

Getting Needed Care

3.3

3.6

3.4

Getting Appointments and Care Quickly

3.4

3.6

3.5

Customer Service

3.5

3.8

3.4

Rating of Health Care Quality

3.3

3.6

3.4

Rating of Health Plan

3.2

3.5

3.2

Care Coordination

3.4

3.7

3.5

Complaints about the Plan

4.8

4.7

4.3

Members Choosing to Leave the Plan

4.0

4.1

3.5

Health Plan Quality Improvement

3.2

3.7

2.6

Plan Makes Timely Decisions about Appeals

4.3

4.6

4.6.

Reviewing Appeals Decisions

4.5

4.6

4.4

Call Center – Foreign Language Interpreter and TTY Availability

4.3

4.6

4.3

Table 11: 2021 - 2023 Average Star Rating by Part D Measure for MA-PDs

Measure

2021 MA-PD Average Star

2022 MA-PD Average Star

2023 MA-PD Average Star

Call Center – Foreign Language Interpreter and TTY Availability

4.4

4.5

4.4

Complaints about the Plan

4.8

4.7

4.3

Members Choosing to Leave the Plan

4.0

4.1

3.5

Drug Plan Quality Improvement

3.5

4.2

2.7

Rating of Drug Plan

3.0

3.4

3.2

Getting Needed Prescription Drugs

3.5

3.8

3.4

MPF Price Accuracy

4.9

4.0

4.2

Medication Adherence for Diabetes Medications

3.7

3.7

3.0

Medication Adherence for Hypertension (RAS antagonists)

3.2

3.9

3.4

Medication Adherence for Cholesterol (Statins)

3.3

3.6

3.1

MTM Program Completion Rate for CMR

3.7

4.0

3.9

Statin Use in Persons with Diabetes (SUPD)

3.1

3.4

3.1

Table 12: 2021 – 2023 Average Star Rating by Part D Measure for PDPs

Measure

2021 PDP Average Star

2022 PDP Average Star

2023 PDP Average Star

Call Center – Foreign Language Interpreter and TTY Availability

4.2

4.2

4.1

Complaints about the Plan

4.9

4.8

4.4

Members Choosing to Leave the Plan

4.1

4.2

4.0

Drug Plan Quality Improvement

4.1

4.1

2.2

Rating of Drug Plan

3.5

3.8

3.3

Getting Needed Prescription Drugs

3.6

3.9

3.5

MPF Price Accuracy

4.9

3.3

3.5

Medication Adherence for Diabetes Medications

3.9

3.9

2.9

Medication Adherence for Hypertension (RAS antagonists)

3.1

3.5

2.7

Medication Adherence for Cholesterol (Statins)

3.6

3.6

3.1

MTM Program Completion Rate for CMR

3.6

3.7

3.1

Statin Use in Persons with Diabetes (SUPD)

3.0

3.3

2.9

APPENDIX

Table A1:  MA-PD Contracts Receiving the 2023 High Performing Icon

Contract ID

Contract Name

Parent Organization

10/2022 Enrollment

5 Star Last Year

Includes SNP Plan Benefit Packages

H0154

VIVA HEALTH, INC.

Triton Health Systems, L.L.C.

52,988

Yes

Yes

H0292

HUMANA HEALTH PLAN OF OHIO, INC.

Humana Inc.

8,284

Yes

No

H0332

KS PLAN ADMINISTRATORS, LLC

UnitedHealth Group, Inc.

43,987

Yes

No

H0524

KAISER FOUNDATION HP, INC.

Kaiser Foundation Health Plan, Inc.

1,335,875

Yes

Yes

H0630

KAISER FOUNDATION HP OF CO

Kaiser Foundation Health Plan, Inc.

113,260

Yes

Yes

H0710

SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.

UnitedHealth Group, Inc.

44,001

Yes

Yes

H1170

KAISER FOUNDATION HP OF GA, INC.

Kaiser Foundation Health Plan, Inc.

36,895

Yes

Yes

H1230

KAISER FOUNDATION HP, INC.

Kaiser Foundation Health Plan, Inc.

35,305

Yes

Yes

H1537

CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.

UnitedHealth Group, Inc.

2,079

Yes

No

H1951

HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.

Humana Inc.

196,857

Yes

Yes

H1961

PEOPLES HEALTH, INC.

UnitedHealth Group, Inc.

89,264

Yes

Yes

H1994

SELECTHEALTH, INC.

Intermountain Health Care, Inc.

43,380

Yes

Yes

H2001

SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.

UnitedHealth Group, Inc.

1,696,070

Yes

No

H2172

KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES

Kaiser Foundation Health Plan, Inc.

109,714

Yes

No

H2256

TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION

Point32Health, Inc.

105,492

Yes

No

H2292

CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.

UnitedHealth Group, Inc.

8,992

Yes

Yes

H2320

PRIORITY HEALTH

BHSH

138,202

No

No

H2425

HMO Minnesota

Aware Integrated, Inc.

8,901

Yes

Yes

H2610

ESSENCE HEALTHCARE, INC.

Essence Group Holdings Corporation

64,129

Yes

Yes

H2697

DEVOTED HEALTH PLAN OF OHIO, INC.

Devoted Health, Inc.

6,985

No

Yes

H3305

MVP HEALTH PLAN, INC.

MVP Health Care, Inc.

28,451

No

Yes

H3344

INDEPENDENT HEALTH BENEFITS CORPORATION

Independent Health Association, Inc.

5,691

Yes

No

H3351

EXCELLUS HEALTH PLAN, INC.

Lifetime Healthcare, Inc.

94,821

Yes

No

H3362

INDEPENDENT HEALTH ASSOCIATION, INC.

Independent Health Association, Inc.

60,142

Yes

Yes

H3388

CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.

Capital District Physicians' Health Plan, Inc.

43,497

Yes

Yes

H3557

BLUE CROSS & BLUE SHIELD OF RHODE ISLAND

Blue Cross & Blue Shield of Rhode Island

10,470

Yes

No

H3660

SUMMACARE INC.

Summa Health

22,935

No

No

H3664

AULTCARE HEALTH INSURING CORPORATION

Aultman Health Foundation

14,564

Yes

No

H3907

UPMC HEALTH PLAN, INC.

UPMC Health System

153,883

Yes

No

H3916

HIGHMARK SENIOR HEALTH COMPANY

Highmark Health

185,355

Yes

No

H3952

KEYSTONE HEALTH PLAN EAST, INC.

Independence Health Group, Inc.

81,418

Yes

No

H3957

HIGHMARK CHOICE COMPANY

Highmark Health

64,611

Yes

No

H4152

BLUE CROSS & BLUE SHIELD OF RHODE ISLAND

Blue Cross & Blue Shield of Rhode Island

56,341

Yes

Yes

H4461

CARITEN HEALTH PLAN INC.

Humana Inc.

152,860

Yes

Yes

H4497

MEDICAL MUTUAL OF OHIO

Medical Mutual of Ohio

9,330

Yes

No

H4513

HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.

Cigna

228,911

No

Yes

H4590

UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.

UnitedHealth Group, Inc.

350,815

Yes

Yes

H4882

HEALTHPARTNERS, INC.

HealthPartners, Inc.

37,115

Yes

No

H5042

CDPHP UNIVERSAL BENEFITS, INC.

Capital District Physicians' Health Plan, Inc.

8,617

Yes

No

H5106

HIGHMARK SENIOR SOLUTIONS COMPANY

Highmark Health

8,905

No

No

H5215

NETWORK HEALTH INSURANCE CORPORATION

Network Health, Inc.

69,870

Yes

Yes

H5262

QUARTZ HEALTH PLAN CORPORATION

University of Wisconsin Hospitals and Clincs Autho

27,175

Yes

Yes

H5296

ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.

Alignment Healthcare USA, LLC

1,273

No

Yes

H5322

CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.

UnitedHealth Group, Inc.

89,116

No

Yes

H5386

SHARP HEALTH PLAN

Sharp Healthcare

10,473

Yes

No

H5431

HEALTHSUN HEALTH PLANS, INC.

Elevance Health, Inc.

53,985

Yes

Yes

H5526

Highmark Western and Northeastern New York Inc.

Highmark Health

23,338

Yes

No

H5533

UPMC HEALTH NETWORK, INC.

UPMC Health System

7,781

Yes

No

H5591

MARTIN'S POINT GENERATIONS ADVANTAGE, INC.

Martin's Point Health Care, Inc.

62,324

Yes

Yes

H5594

OPTIMUM HEALTHCARE, INC.

Elevance Health, Inc.

56,857

Yes

Yes

H5652

SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.

UnitedHealth Group, Inc.

5,723

Yes

Yes

H6723

MEDICAL MUTUAL OF OHIO

Medical Mutual of Ohio

26,063

No

No

H7917

BLUECROSS BLUESHIELD OF TENNESSEE, INC.

BlueCross BlueShield of Tennessee

138,347

No

No

H8142

SCOTT AND WHITE HEALTH PLAN

Baylor Scott & White Holdings

25,800

No

No

H9096

DEAN HEALTH PLAN, INC.

Medica Holding Company

10,457

Yes

No

H9808

CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA

Moses H. Cone Memorial Hospital Corp.

13,944

Yes

No

H9834

QUARTZ HEALTH PLAN MN CORPORATION

University of Wisconsin Hospitals and Clinics Authority

3,231

Yes

No

Table A2: 1876 Cost Contracts Receiving the 2023 High Performing Icon*

Contract ID

Contract Name

Parent Organization

10/2022

Enrollment

5 Star Last Year

H1651

MEDICAL ASSOCIATES HEALTH PLAN, INC.

Medical Associates Clinic, P.C.

14,516

Yes

H5256

MEDICAL ASSOCIATES CLINIC HEALTH PLAN

Medical Associates Clinic, P.C.

3,772

Yes

H5264

DEAN HEALTH PLAN, INC.

Medica Holding Company

14,479

Yes

*1876 Cost Contacts do not offer SNPs

Table A3: PDP Contracts Receiving the 2023 High Performing Icon

Contract ID

Contract Name

Parent Organization

10/2022 Enrollment

5 Star Last Year

S3521

EXCELLUS HEALTH PLAN, INC.

Lifetime Healthcare, Inc.

5,871

Yes

S4501

INDEPENDENT HEALTH BENEFITS CORPORATION

Independent Health Association, Inc.

7,179

Yes

###


[1] Percentages in the tables may not sum to 100 due to rounding.

[2] See CY 2020 and 2021 final rule (CMS-4185-F) at Federal Register :: Medicare and Medicaid Programs; Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, Programs of All-Inclusive Care for the Elderly (PACE), Medicaid Fee-For-Service, and Medicaid Managed Care Programs for Years 2020 and 2021.  See also the CY 2022 Rate Announcement at Announcement of Calendar Year (CY) 2022 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (cms.gov) (explaining how the change in the collection of HEDIS data in 2020 resulted in this measure being on the display page for the 2021 and 2022 Star Ratings to comply with § 422.164(d)(2)).

[4] The introduction of guardrails was initially finalized for the 2022 Star Ratings in the CY 2020 and 2021 final rule (CMS-4185-F). Implementation was delayed by one year in an interim final rule with comment that appeared in the Federal Register on April 2, 2020, so cut points for the 2022 Star Ratings (based on 2020 measurement year) could change by more than 5 percentage points if national performance declined as a result of the COVID-19 PHE.  See Interim final rule with comment (CMS-1744-IFC) at Federal Register :: Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency.

[5] See CY 2021 final rule (CMS-4190-F).

[7] 42 C.F.R. §§ 422.166(h)(1)(i), 423.186(h)(1(i).

[8] 42 C.F.R. §§ 422.166(h)(1)(ii), 423.186(h)(1)(ii).

[9] The qualifying extreme and uncontrollable circumstances for the 2021 performance period include Texas winter storms and Hurricane Ida. See 2023 Rate Announcement at https://www.cms.gov/files/document/2023-announcement.pdf.

[10] For more information about cut points, see CY 2020 and 2021 final rule (CMS-4185-F).