A couple of private Medicare insurers in Illinois—including the largest insurance company in the state—have some work to do when it comes to star ratings. Medicare Advantage plans from Health Care Service Corp., or HCSC, and Family Health Network, or FHN, have landed on the Centers for Medicare & Medicaid Services’ short list of low-performing contracts, according to data released Oct. 10 by the federal agency. The agency’s five-star system rates such Medicare Advantage contracts with prescription drug coverage on up to 46 measures like access to care, member communication and clinical quality. Despite achieving moderate three-star ratings overall, both HCSC’s Blue Cross & Blue Shield of Illinois and FHN’s Community Care Alliance of Illinois earned only 2.5 stars in one of two categories for the third consecutive year. Blue Cross earned 2.5 stars for Part C—which covers at least the same services as traditional Medicare—and 3.5 stars for Part D prescription drug coverage. Community Care earned three stars for Part C and 2.5 stars for Part D. Plans that achieve four or more stars receive a 5 percent boost to their monthly per-member payments from Medicare. Ratings are made public prior to open enrollment so beneficiaries can take performance into account when selecting a plan. On the flip side, the Centers for Medicare & Medicaid Services, or CMS, retains the right to terminate Medicare Advantage contracts that fail to achieve above 2.5 stars in one or both categories over the course of three years. Blue Cross, Community Care and the other two contracts on the list—Affinity Health Plan and Gateway Health Medicare Assured—fall into that bucket. Beneficiaries in Illinois have 113 Medicare Advantage plans to choose from for 2019.
Menu
