Why Kaiser Permanente
Feel better with Star quality
Medicare health and prescription drug plans are rated for excellence by the independent Centers for Medicare & Medicaid Services. The highest rating is 5 out of 5 stars.
Who created the Medicare Star Quality Ratings?
The Medicare Star Quality Rating System was developed by the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers the Medicare program.* The ratings are updated annually based on ongoing monitoring and analysis.
The Medicare Star Quality Rating System is unique because it's based on more than 50 measures including clinical performance, customer service, and member satisfaction. CMS uses 5 main sources to measure Medicare plans and compile the ratings:
- The HEDIS® (Health Plan Employer Data and Information Set)
- The Consumer Assessment of Healthcare Providers and Systems (CAHPS) member satisfaction survey
- Surveys of members' health status
- Information from members' complaints and appeals
- Medicare's own monitoring activities
Why these ratings are so important:
The Medicare Star Quality Ratings are a simple, authoritative starting point and may be the single most important criteria you can use to tackle the challenge of comparing Medicare health plans in your area.
How the Medicare Star Quality Rating System works
A simple, objective way to compare Medicare health plans in your area.
It gives Medicare beneficiaries an independent way to compare Medicare health and prescription drug plans on overall quality and service—and determine the highest quality plans in their area.
Here's how it works:
Each Medicare health plan is assigned an overall rating from 5 stars to 1 star, based on the plan’s performance in more than 50 specific areas across 9 general categories. The ratings are updated annually based on ongoing monitoring and analysis. However, some plans may be too new or not have enough data to be rated.
Here's what the number of stars represents:
5 Excellent performance
4 Above average performance
3 Average performance
2 Below average performance
1 Poor performance
What exactly is rated for each Medicare health plan?
The ratings system analyzes Medicare health plan performance across more than 50 distinct areas. Each area is assessed individually and assigned a star quality rating to reflect that assessment. The highest rating is 5 stars for excellent performance. The lowest rating is 1 star for poor performance.
The Centers for Medicare & Medicaid Services measures how well health and prescription drug plans perform on more than 50 items, which are grouped into different categories:
Medicare health plans are rated on how well they perform in five different categories:
- Stay healthy: screenings, tests, and vaccines
- Managing chronic (long-term) conditions
- Member experience with the health plan
- Member complaints, problems getting services, and improvement in the health plan's performance
- Health plan customer service
Medicare drug plans are rated on how well they perform in four different categories:
- Drug plan customer service
- Member complaints, problems getting services, and improvement in the drug plan's performance
- Member experience with drug plan
- Patient safety and accuracy of drug pricing
Learn more about the ratings at the Medicare web site†.
Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next. Centers for Medicare & Medicaid Services Health Plan Management System, Plan Ratings 2015. Kaiser Permanente contract #H0524, #H0630, #H1170, #H1230, #H2150, #H9003.
*A branch of the U.S. Department of Health & Human Services.†Kaiser Permanente is not responsible for the content or policies of external Internet sites.
Your doctor? Your decision.
We have an extensive network of doctors to choose from. All of our available physicians accept Medicare health plan members.
Choosing the right doctor is an important decision. But don’t worry — if you change your mind, for any reason, you can switch to a new Kaiser Permanente doctor at any time.
To help you determine which doctor is right for you, our online physician directory provides information on our doctors, including education, background, credentials, specialties, profile photos, and more.
Browse our online directories and see how simple it is to find a doctor or a medical facility in your area.
Access to a full range of specialists
When you need to see a specialist, you’ll get access. Your primary doctor will work together with any of our specialists you see to coordinate your treatment.
Manage your health online anytime, anywhere — with My health manager
We believe your health information should be available to you anytime, for any reason. With My health manager you can email your doctor's office, view most test results as soon as they're available, schedule or change routine appointments, refill most prescriptions, and more* — all from your computer or mobile device. Get a guided tour of My health manager.
A single plan gives you what you need
Kaiser Permanente stands apart from other Medicare health plans by providing coordinated care as well as coverage. Our doctors, nurses, pharmacists, and X-ray and lab technicians all work together for you and are usually in one location.
When you choose a Kaiser Permanente Medicare health plan, you'll get hospital, medical, and preventive care services. Many of our plans also include prescription drug coverage.
You're covered when you travel
Wherever you go as a Kaiser Permanente Medicare health plan member, you're covered worldwide for emergency or urgent care from any medical provider.
*Some online services are not available in all regions.
A personal connection
Our medical professionals are dedicated to providing you with compassionate, personalized care. And you'll have peace of mind knowing everyone on your medical team — including you — has instant and secure access to your most up-to-date health information with our comprehensive electronic medical record system.
To help you stay well, we offer many preventive services -- like mammograms, flu shots, cholesterol screenings, and an Annual Wellness Visit -- at no additional cost. We'll help you manage ongoing health conditions to keep you feeling your best.
Focused on your well-being
We have a variety of programs including health education and fitness classes to help you get and stay healthy. (Some classes may require a fee.)
We've got the experience
Kaiser Permanente has participated in the Medicare program since its inception in 1965, and has a long history of providing personalized, high-quality care and service to its members.
Today we provide Medicare health plan coverage to more than 1.2 million members program wide.
Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year, and for group members, at other times in accord with your group’s contract with us. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayment, and restrictions may apply.
Acknowledged for health care leadership
Our care and services, including our Medicare health plans, regularly earn accolades from consumer watchdogs and other groups that monitor or regulate the health care industry.
Choose the Medicare health plan with real star power*
Kaiser Permanente Medicare health plans received 5 out of 5 stars for 2015* -- the highest possible rating, in California, Colorado, Hawaii, Oregon, Washington, Maryland, Virginia, and Washington D.C. In Georgia, Kaiser Permanente Medicare health plans received 4.5 out of 5 stars in 2015. The Centers for Medicare & Medicaid Services (CMS) rates the excellence of Medicare health and prescription drug plans based on major categories that include preventive care, chronic care, prescription drug services, customer service, and member satisfaction.
Kaiser Permanente Medicare health plans were ranked among the nation's bestFor the fourth year in a row, all Kaiser Permanente Medicare health plans were ranked among the nation's best in the National Committee for Quality Assurance’s (NCQA) Medicare Health Insurance Plan Rankings. The NCQA ranks health plans in 3 categories, including customer experience, prevention and treatment. In the 2015 NCQA study, all seven Kaiser Permanente Medicare health plans are in the Top 10 out of more than 408 Medicare plans ranked by NCQA and are all above the 97th percentile.1
Straight A’s for hospital safety
In 2014, 35 Kaiser Permanente hospitals were given an A grade for patient safety, out of 2,522 hospitals included in Leapfrog’s annual report. 19 of our hospitals were also named 2013 “Top Hospitals”†, out of 1,324 hospitals nationwide. The Leapfrog Group honors medical centers for their outstanding success in areas such as reducing infection rates, safety practices, mortality rates for common procedures and measures of efficiency.2
‘Top Performers’ in quality and safetyIn 2013, 27 Kaiser Permanente facilities were honored as “Top Performer” for Quality and Safety out of 3,343 eligible facilities by The Joint Commission, the leading accreditor of health care organizations in the United States. The program spotlights exemplary performance on key quality measures, including heart attack, heart failure, surgery, stroke, and inpatient psychiatric services.
MedicareWebWatch Certification of Excellence
For 2014, Kaiser Permanente’s Medicare health plan website received the highest overall rating† for a fourth straight year. Kaiser Permanente's Medicare health plan site was one of only 14 Medicare Advantage Internet sites selected for certification, and among six recognized as a benchmark site. MedicareWebWatch is dedicated to identifying Medicare Advantage plan websites that offer a high-value, positive experience for plan members, caregivers and other guests.3
For more information about Kaiser Permanente’s awards and honors, visit kp.org/quality.
NCQA, Leapfrog, The Joint Commission, and MedicareWebWatch awards were not given by Medicare. Official CMS Star Ratings can be found at medicare.gov†.
*Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next. Centers for Medicare & Medicaid Services Health Plan Management System, Plan Ratings 2015. Kaiser Permanente Contract #H0524, #H0630, #H1170, #H1230, #H2150, #H9003.
1The National Committee for Quality Assurance (NCQA) is a private, not-for-profit organization dedicated to improving health care quality. It issues health insurance plan rankings and Quality Compass Health Plan Quality Measures for Commercial and Medicare plans each year. In 2011-2012 NCQA evaluated 403 Medicare health plans. In 2012-2013 NCQA evaluated 465 Medicare health plans. In 2013-2014 NCQA evaluated 405 Medicare health plans.
2The Leapfrog Group is a national nonprofit organization founded in November 2000 using the collective leverage of large purchasers of health care to initiate breakthrough improvements in the safety, quality and affordability of health care for Americans.
3The independent research firm rated 137 Medicare health plan websites in 2014, 133 in 2013, 137 in 2012, and 137 in 2011 nationwide.
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†Kaiser Permanente is not responsible for the content or policies of external Internet sites.
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