Consumer Reports Ranks, Scores Medicare Advantage,
Other Health Plans for 2014
CR finds that higher cost does not mean better care;
complete report in magazine, rankings free online, Medicare open
enrollment starts October 15
5, 2013 – Open enrollment for Medicare opens on October 15 and seniors
should be exploring their options in insurance plans for 2014. For the
fourth year, Consumer Reports is publishing rankings of hundreds of
health insurance plans, including Medicare Advantage plans, and, for the first time, plans available in Obamacare. Among new
choices in the health plan are Medicaid HMOs. This is also the first
time for the organization to take additional steps to identify plans
that both provide high-quality care and avoid costly care.
The rankings data and the “Best Value” designation
come from the National Committee for Quality Assurance (NCQA), a
respected non-profit health care quality measurement group. Overall,
Consumer Reports and NCQA have information on more than 1,000 private,
Medicare Advantage, and Medicaid plans.
Diabetes management key to Best Value rating
The new Best Value designation for plans is based
on how well a plan helps people with diabetes manage their condition.
Consumer Reports focused on diabetes for several reasons. The disease
has reached epidemic proportions, affecting some 26 million Americans.
In addition, managing diabetes requires good, basic care for things like
high blood pressure, cholesterol, and blood glucose levels—as well as
coordination among providers. Plans that get diabetes care right are
likely to do a lot of things well.
Tip from Consumer Reports
I am in Medicare, what do I do about Obamacare?
You don’t have to do anything or buy anything extra.
Medicare Part A and Advantage plans fully qualify as insurance
under the new law. And nothing significant about Medicare is
changing in 2014. Benefits and programs will work the same as
they do now. But there is one situation in which the new health
care law might help: You are a new enrollee and your spouse
isn’t on Medicare yet.
Once the older spouse enrolls in Medicare, the younger, often
nonworking spouse, may suddenly be without insurance. The spouse
often has a hard time buying an individual policy because of
the younger spouse can buy a plan on the marketplace and not
worry about getting turned down or charged extra on the basis of
a pre-existing condition.
Note: If you’re the younger spouse, you’ll need to put down your
joint income when applying for marketplace coverage, even though
you’re the only one doing the buying. Your subsidy, if any, will
be based on that number.
Finally, treating diabetes is expensive, especially
if basic care is neglected, so plans that provide good diabetes care for
less money should have more resources available to cover other
conditions or to reduce premiums.
The analysis of 997 Medicare plans
identified 114 that got a Best Value designation, earning check marks
for both providing high quality care and avoiding costly care. Many more
- 402 plans - got a check mark for one but not both of those measures.
And, 481 plans didn’t get a check mark for either. That could be because
they had poor results for these measures or they did not report the data
needed for this analysis.
High cost not always equal better care
“Consumer Reports’ analysis found that expensive
care doesn’t mean better care. Many people incorrectly assume that the
more money that’s spent on health care, the better health care will be,”
said John Santa, M.D., medical director of Consumer Reports Health. “But
as these ratings show, the data found no connection between cost and
The rankings could be especially valuable to
consumers this year because health insurance becomes a requirement for
just about everyone in the U.S. on January 1, 2014 under the federal
Affordable Care Act (ACA). Though much attention is now being focused on
the ACA, at least 80 percent of
Americans will notice almost no change because they already have
insurance that meets the law’s requirements. This includes the 49
percent of Americans who get health insurance through their or someone
else’s job, as well as people who get insurance through Medicare or some
other type of government plan.
The centerpiece of the transformed health care
system is an entirely new way of choosing and purchasing individual
health insurance known generically as marketplaces. They opened for
business on October 1, 2013, in every state. In subsequent years, it
will take place on the same schedule as Medicare open enrollment: Oct.
15 through Dec. 7.
Plans listed in these new marketplaces and in this
Consumer Reports/NCQA insurance ranking aren’t identical. That’s because
all the plans in the marketplace are new, so NCQA doesn’t yet have data
for them. Nonetheless, a plan’s record in a specific state provides a
good indication of how well a new and similar marketplace plan by the
same provider may perform.
Medicare Open Enrollment
Oct. 15 - Dec. 7
people with Medicare can choose their plans for 2014
Consumer Reports’ publication of NCQA ranking of
more than 1,000 private, Medicare Advantage, and Medicaid
health insurance plans nationwide can be viewed through the lens of
coverage via an employer (or through a family member’s), through
Medicare or Medicaid, or insurance on-your-own through the new health
The report provides overall scores from 1 to 100
reflecting plans’ performance across many aspects of care. These include
cancer screenings, immunizations and other preventative services, and
treatments for chronic diseases such as heart disease, osteoporosis and
mental illness. Customer satisfaction and results from NCQA
accreditation surveys also contribute to the overall scores.
Consumer Reports has created a free online tool at
www.HealthLawHelper.org to help consumers better understand how they
may be impacted by the Affordable Care Act. After answering a series of
questions about family, income and current insurance (if any), consumers
receive personalized information on what options they may have. They
will not be given a particular insurance plan to buy, but advice on how
to make the best decision.
www.HealthLawHelper.org is free and confidential and is also
available in Spanish at
If you get
insurance through Medicare:
Americans 65 and older almost
always qualify for Medicare coverage. You can also enroll in
a Medicare Advantage HMO or PPO. To see whether the plans
make sense for you, go to
ConsumerReports.org/medicare. Then look at the rankings of
Medicare Advantage HMOs and PPOs in Consumer Reports to see
how the options compare on overall score, their consumer
satisfaction score, and whether they earned a Best Value
Also check Medicare’s website,
the plans’ star rating scores. NCQA’s rankings reflect much
of the data you’ll find there, but Medicare also includes
some of its own data.--Most important, Medicare pays bonuses
to plans that earn three or more stars in its scoring
system, so plans that score high in the Medicare star
ratings may have more funds to spend on your care.
If you get insurance through
More people than ever will now be
eligible for Medicaid, because of changes from the
Affordable Care Act. To see NCQA rankings for Medicaid HMOs,
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