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Medicare & Medicaid News

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

Oct. 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.


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The full report is available in the November issue of Consumer Reports. The latest health plan rankings are also available for free online at

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 pre-existing conditions.

Now 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 quality.”

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

When people with Medicare can choose their plans for 2014

Click to Medicare Site

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 exchange marketplaces.

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 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. 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 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 check mark.

Also check Medicare’s website,, for 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 Medicaid:

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, go to


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