Humana Earns High Marks from Medicare’s Star Ratings

Posted on: November 23rd, 2012 by Sarah

Customers with a Medicare plan through Universal Health Insurance received a letter recently telling them that it may be in their best interest to shop around for a better health plan.  Medicare Advantage Plans are run by private health insurance companies, but the companies are being rated by the government to ensure a good quality of care.  According to The Tampa Bay Times’ Stephen Nohlgren, signing customers up for a Medicare Advantage plan can mean hundreds of dollars a month coming in for insurers.  For the past five years, Medicare has been using a star rating system to rate the quality of the plans’ care and service.  In “Medicare’s star ratings help you decide, but aren’t simple,” Nohlgren says that companies who receive a rating below three stars (out of five) for three years have a red warning label attached to their plans.  That is where Universal stands right now.

Humana has the most Medicare participants in Florida and is doing a good job taking care of them.  Their Gold Plus HMO plan earned 4.5 out of 5 stars.  Humana has been working hard for the past four years to improve their quality and their overall scores.  One of their biggest undertakings was the hiring of a nurse “star czar” who works to teach all of the employees how their actions directly affect the Medicare ratings.  Star ratings are based on 54 different things based in customer service and clinical numbers like blood pressure.  Doctors received $34 million in bonuses for exhibiting behaviors with their patients that Medicare likes and documenting their work so that the company can submit it to the government.  They even gave small gifts to patients who got health screenings or tests recommended by the government.  Humana’s 4.5 stars will earn them a bonus of nearly $160 million in 2012.

It is not clear whether the ratings have much of an impact on which Medicare plan consumers choose.  Most beneficiaries just keep the same plan from year to year, although consumer groups have seen an increasing concern after the letters went out regarding Universal’s low ratings.  December 7 is the deadline for selecting a Medicare plan for 2013, unless you are going to an insurance company with five stars.  No one in Florida has earned those high marks, but nationwide there are some companies with five stars.  Those companies are allowed to advertise and obtain new members throughout the year, not only during open enrollment times.  Humana is determined to get five stars in their next rating, while Universal is focused on getting out of the red and above the three stars rating.


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