Star Ratings and Quality of Care
Star ratings are a key metric for assessing the quality of Medicare Advantage plans. These ratings, published annually by the Centers for Medicare & Medicaid Services (CMS), help consumers compare the quality of different plans.
Aetna’s commitment to delivering high-quality care is reflected in its star ratings, which consider various performance measures, including clinical quality and patient experience.
Understanding star ratings can help you make an informed decision when choosing a Medicare Advantage plan, ensuring that you select a plan that meets high standards of care and service.
Understanding Star Ratings
Star ratings provide a clear, comparative measure of the quality of Medicare Advantage plans. Each plan is rated on a scale from one to five stars, with five being the highest.
These ratings are based on various categories, including customer service, member experience, and quality of care. For Medicare Advantage plans with prescription drug coverage, up to 38 unique quality and performance measures are assessed, while MA-only plans are rated on up to 28 measures.
The Centers for Medicare & Medicaid Services (CMS) uses these ratings to ensure that plans meet specific standards. The weight given to patient experience, complaints, and access measures increased significantly for the 2023 star ratings, highlighting the importance of these aspects in overall plan quality.
Understanding these ratings helps consumers choose plans that provide excellent care and service.
Aetna’s Performance
Aetna has shown significant improvement in its star ratings over the past year. In 2023, only 21% of Aetna’s Medicare Advantage members were enrolled in plans that earned four stars or more. However, by 2024, this figure had dramatically increased to 87%, reflecting Aetna’s efforts to enhance patient experience and care management programs.
This rebound in ratings is attributed to several factors, including improved patient experience survey scores and enhanced care management programs. Aetna’s commitment to delivering high-quality care and service is evident in these improved ratings, making their Medicare Advantage plans a reliable choice for many.
Institutional Special Needs Plans (I-SNPs)
Institutional Special Needs Plans (I-SNPs) are specially designed Medicare Advantage plans that cater to individuals who require nursing home level care or the level of care provided in long-term care facilities. Aetna offers I-SNPs tailored for individuals residing in institutions such as nursing homes, ensuring that their specific healthcare needs are met.
These plans provide coordinated care services, involving a team of healthcare providers who work together to manage a patient’s care. This coordinated approach helps manage chronic conditions more effectively and ensures comprehensive support for individuals requiring long-term care.
What Are I-SNPs?
Institutional Special Needs Plans (I-SNPs) are Medicare Advantage plans designed for individuals who live in long-term care facilities or require nursing home level care for at least 90 days. These plans are tailored to meet the specific needs of beneficiaries in institutional settings like nursing homes, providing specialized care and support.
I-SNPs must arrange for institutional level of care assessments to be administered by an independent, impartial party to ensure that the care provided meets the required standards. This ensures that the care is both appropriate and effective for those living in long-term care facilities.
Eligibility and Enrollment
To qualify for an I-SNP, individuals must:
- Have resided, or are expected to reside, in a skilled nursing facility for an extended period
- Eligibility is defined by the requirement to live in a long-term care facility or similar institutional setting for more than 90 days.
Enrollment in I-SNPs is open to those living in the community but requiring an institutional level of care, and can be conducted throughout the year for eligible individuals. This flexibility ensures that those needing specialized care can access it when they need it most.
