CMS Announces Star Ratings Will Expand to ACA Health Plans

Health plans on the Affordable Care Act (ACA) exchanges will be required to display quality ratings starting with the 2020 plan year, according to an announcement from CMS, which is expanding the 5-star rating system it uses on Medicare plans to the health insurance exchanges.

The star rating system measures how well plans perform and scores them on 3 categories: member experience, medical care, and plan administration. The purpose of the rating system is to help consumers make informed decisions, to facilitate oversight of health plans, and to provide actionable information to health plans so they can improve the quality of their services.

“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,” CMS Administration Seema Verma said 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 benefitting the most.”

Under the star rating system, plans are given a rating with 5 representing the highest quality. CMS already conducted a pilot by displaying stars on HealthCare.gov for plans in Virginia and Wisconsin during the 2017 and 2018 open enrollment periods. That pilot was expanded to include Michigan, Montana, and New Hampshire during the 2019 open enrollment period.

When the 2020 open enrollment period begins, quality ratings will now be displayed n HealthCare.gov. The plan will show the number of stars (1-5) toward the top and patients will also be told if an individual plan hasn’t been rated. State-based exchanges will have flexibility to display extra state or local quality information.

All issuers offering plans on the exchanges that offered coverage during the previous plan year and the current year and that have more than 500 enrollees will be required to submit quality data to CMS, according to the fact sheet. There are 38 quality measures—28 clinical quality measures assessing general performance of the quality of services provided and 10 survey measures assessing enrollees’ experience with the health plan.

The announcement comes amid reports that the administration is trying to come up with a plan to fully replace the ACA. The Hill reported that a Trump health administrator said officials are working on a plan to repeal and replace the ACA. However, any action will likely have to wait until after the 2020 elections since Democrats currently control the House.