Medicare Star Ratings
Simply THE BEST
UPMC for Life has earned an excellent 5 out of a possible 5 overall star rating for both its HMO and PPO plans from the Centers for Medicare & Medicaid Services (CMS) for 2022. We've also received National Committee for Quality Assurance (NCQA) Accreditation! Plus, U.S. News & World Report recognized us as one of the Best Medicare Advantage Plans in PA for 2022.
These awards place us among the highest-rated Medicare plans in the nation. They are based on how well Medicare Advantage plans deliver medical coverage, prescription drug services, customer service, and member satisfaction. You can use these scores to see how we are doing on quality and performance compared to other Medicare plans.
How do Medicare Star Ratings work?
5 out of 5 Stars for HMO and PPO
Every year, Medicare (CMS) evaluates plans based on a 5-star rating system to assist Medicare beneficiaries and their families in comparing plans based on quality and performance. The Medicare star ratings are based on how well Medicare Advantage plans deliver medical coverage, prescription drug services, and customer service. The score also includes how current members rate their satisfaction with the plan.
CMS uses up to quality and performance measures to rate plans. Ratings range from a low “1” star, which is poor, to the highest possible “5” stars, which is excellent. Medicare’s 5-star rating is given by CMS, the federal program that governs all Medicare plans, which means it cannot be paid for—it must be earned.
Among the areas CMS uses to determine star ratings include:
- Feedback from members about the plan’s service and care
- The number of members who left or stayed with the plan
- The number of complaints Medicare got about the plan
- Data from doctors and hospitals that work with the plan
Why are the star ratings important?
More stars mean a better plan–members get better care, better quality, and better customer service. Medicare beneficiaries can use this score to compare quality and performance of Medicare plans. This important tool can help beneficiaries choose the best Medicare plan to fit their needs.
The National Committee for Quality Assurance (NCQA) is a private, nonprofit organization dedicated to improving health care quality.* NCQA accredits and certifies a wide range of health care organizations and recognizes clinicians in key clinical areas. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. HEDIS measures performance in health care where improvements can make meaningful differences in people’s lives including effectiveness and availability of care and utilization.
Among the areas NCQA uses to determine accreditation include:
- Quality management and improvement
- Members’ rights and responsibilities
- Network management
- Care and service performance
Why is accreditation important?
When a health plan is accredited, it means that they demonstrate their commitment to quality in several key areas included safety, operational efficiency, and patient care coordination and satisfaction.
These ratings also help UPMC for Life maintain the strong benefits and programs currently offered to members and reflect the strength and stability of our products over the last several years.
All the Awards!
We’ve also been recognized across some of the most prestigious award platforms in the United States, including J.D. Power, for providing an “Outstanding Customer Service Experience” for phone support.**
**J.D. Power 2020 Certified Customer Service ProgramSM recognition is based on successful completion of an evaluation and exceeding a customer satisfaction benchmark through a survey of recent servicing interactions.
To our members…
Thank you to our members for helping us achieve these awards! You may not realize it, but our excellent star rating and accreditation is thanks in large part to you! These scores reflect our commitment to offering the best possible care and coverage to our members every day. We could not have accomplished such a great score without you, and we are so thankful to serve each and every one of you!
*UPMC for Life was rated 4 out of 5 stars for its HMO plans and 4.5 out of 5 stars for its PPO plans in NCQA’s Medicare Health Plan Ratings 2021.