The Centers for Medicare and Medicaid announced last week that its 5-star quality rating system, which it used in a pilot program in Virginia and Wisconsin during 2017 and 2018’s open enrollment periods, will be expanded to the whole of the health insurance exchanges.

Starting with the 2020 plan year, exchanges will have to display star ratings (already used on Medicare plans), which rate plans on how well they perform in 3 categories: member experience, medical care and plan administration.

“Knowledge is power, and for the first time, consumers will have access to meaningful, simple-to-use information to compare the quality, along with the price, of health plans on Exchange websites, including HealthCare.gov,” said CMS Administrator Seema Verma in a statement. “This addresses our strongly held commitment to equip consumers with the tools they need to find the best choice possible. Increasing transparency and competition drive better quality and cost, with consumers benefiting the most.”

Michigan, Montana, and New Hampshire were added to the star rating system for the 2019 open enrollment period, but now HealthCare.gov will display ratings for the whole country, as well as indicating if an individual plan has not been rated. It warns that just because a plan has not been rated does not mean it has a bad rating.

Plan issuers that provided coverage during the previous plan year and the current year that have more than 500 enrollees will be required to submit data on 38 quality measures (28 clinical, assessing quality of care, and 10 survey, assessing enrollees’ experience with the plan) to CMS.

The open enrollment period for 2020 runs from November 1, 2019 to December 15, 2019. In addition, the agency says it is making star ratings and quality measure level data from the 2019 plan year available in a public use file for the use of “the public, researchers, agents, brokers, states, health issuers, and consumer groups to allow them to use and analyze the data.” It will also release the star ratings data for the 2020 plan year closer to open enrollment.

The public use file, says CMS, “’includes underlying measure data as well as star ratings for all issuers, operating in all exchange types that were eligible to receive star ratings for the specified plan year.”

While the data are primarily intended for researchers, it is also accessible by other entities, including the general public, as they seek additional information on plans available on the exchanges.

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CMS star rating plan expanding to all ACA exchanges

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