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Comparing Health Care Providers



How do I compare the quality fo Health Care Providers?
Medicare collects information about the quality and safety of medical care and services given by most health care providers (and facilities).

Check Medicare.gov/quality-care-finder and get a snapshot of the quality of care they give their patients. Some feature a star rating system to help you compare quality measures that are important to you.

Find out more by:

  • Talking to your health care provider. Each health care provider should have someone you can talk to about quality.
  • Asking your doctor or other health care provider what he or she thinks about the quality of care other providers give. You can also ask your doctor or other health care provider about the quality of care information you find on Medicare.gov.
Having access to quality and cost information upfront helps you get a complete picture of your health care options. You'll be able to compare quality ratings, cost information, and other details to help you get the best value for your health care.


How do I compare the quality of Medicare health and drug plans?
The Medicare Plan Finder at Medicare.gov/plan-compare features a star rating system for Medicare health and drug plans. The Overall Star Rating gives an overall rating of the plan's quality and performance for the types of services each plan offer.



For plans covering health services, this is an overall rating for the quality of many medical/health care services that fall into 5 categories and includes:


1. Staying healthy - screening tests and vaccines: Whether members got various screening tests, vaccines, and other check-ups to help them stay healthy.

2. Managing chronic (long-term) conditions: How often members with certain conditions got recommended tests and treatments to help manage their condition.

3. Member experience with the health plan: Member ratings of the plan.

4. Member complaints and changes int the health plan's performance: How often members had problems with the plan. Includes how much the plan's performance improved (if at all) over time.

5. Health plan customer service: How well the plan handles member calls questions.








For plans that cover the prescription drug, this is an overall rating for the quality of prescription-related services that fall into 4 categories and includes:

1. Drug plan customer service: How well the plan handles member calls and questions.

2. Member complaints and changes in the drug plan's performance: How often members had problems with the plan. Includes how much the plan's performance improved over time. 

3. Member experience with drug plan: Member ratings of the plan.

4. Drug safety and accuracy of drug pricing: How accurate the plan's pricing information is and how often members with certain medical conditions are prescribed drugs in a way that's safer and clinically recommended for their condition.


For plans that cover both health services and prescription drugs, the overall rating for quality and performance covers all the topics above. 

You can compare the quality of health care providers and Medicare plan services nationwide by visiting Medicare.gov or by calling your State Health Insurance Assistance Program (SHIP). 






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Medicare Part D Costs for 2020

Before 2006, Medicare did not cover prescription medications. There was a limited number of medications that were offered under Medicare Part Band,  and otherwise, you had to pay for your medications out of pocket. In 2003, everything had changed when President George W. Bush passed the Medicare Prescription Drug, Improvement, and Modernization Act (MMA). This is what we now know of as  Medicare Part D , an optional part of Medicare that provides prescription drug coverage. Part D plans are run by private insurance companies and not by the government. However, the federal government sets guidelines on what basic medications are covered and how much you can be charged.  A deductible is the amount of money you spend out of pocket before your prescription drug benefits begin. Your plan may or may not have a deductible. The maximum deductible a plan can charge for 2020 is set at $435. It has increased by  $20 from 2019. Part D
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Benefit Period

The benefit period is the length of time during which a benefit is paid. It   measures your use of  inpatient  hospital and  skilled nursing facility (SNF)  services. This  begins the day you are admitted as an inpatient, or to an SNF, and ends the day you have been out of the hospital or SNF for 60 days in a row. After you meet your  deductible ,  Original  Medicare  will pay in full for days 1 to 60 that you are in a hospital. The remaining days, 61-90 , you will have to pay a  daily coinsurance. If your 90 days of hospital coverage has been consumed but you need to stay longer, Medicare covers up to 60 additional lifetime reserve days and yo u will also have to pay a daily  coinsurance . These days are nonrenewable , meaning you will not get them back when you become eligible for another benefit period. If you run out of days during your benefit period, Medicare will stop paying for your in-patient related hospital costs such as room and board.  To be eligible for a new b
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