Association Between Medicare Advantage Plan Star Ratings and Enrollment

Rachel O. Reid, MS; Partha Deb, PhD; Benjamin L. Howell, PhD; William H. Shrank, MD, MSHS

JAMA. 2013;309(3):267-274. doi:10.1001/jama.2012.173925.

ABSTRACT

Importance The US Centers for Medicare & Medicaid Services publishes star ratings reflecting Medicare Advantage plan quality to inform enrollment decisions.

Objective To assess the association between publicly reported Medicare Advantage plan quality ratings and enrollment.

Design, Setting, and Participants Cross-sectional study of 2011 Medicare Advantage enrollments among 952 352 first-time enrollees and 322 699 enrollees switching plans.

Main Outcome Measure Association between star ratings and enrollment was modeled using conditional logit regression, controlling for beneficiary and plan characteristics.

Results Among the 952 352 included first-time enrollees, a 1-star higher rating was associated with a 9.5 (95% CI, 9.3-9.6) percentage-point increase in likelihood to enroll. The highest rating available to a beneficiary was associated with a 1.9 (95% CI, 1.8-2.1) percentage-point increase in likelihood to enroll. Among the 322 699 enrollees switching plans, a 1-star higher rating was associated with a 4.4 (95% CI, 4.2-4.7) percentage-point increase in likelihood to enroll. A rating at least as high as a beneficiary's prior plan was associated with a 6.3 (95% CI, 6.0-6.6) percentage-point increase in likelihood to enroll. Star ratings were less strongly associated with enrollment for black, rural, low-income, and the youngest beneficiaries.

Conclusion and Relevance Medicare's 5-star rating program for Medicare Advantage is associated with beneficiaries' enrollment decisions.