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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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NCOV -19 and MEDICARE 2020

Medicare Part B , which includes a variety of outpatient services cover medically necessary clinical diagnostic laboratory tests when a doctor or other practitioner orders them. Medically necessary clinical diagnostic laboratory tests are generally not subject to coinsurance or deductible. It will cover medically necessary imaging tests, such as computed tomography (CT) scans, as needed for treatment purposes for lung infections, however not for screening asymptomatic patients. For those imaging tests paid by Part B, beneficiary coinsurance and deductible would apply. If the Part B deductible ($198 in 2020) applies to the Part B services, beneficiaries must pay all costs - up to the approved amount of Medicare until the beneficiary meets the yearly Part B deductible. Once it is met, Medicare pays its share, and beneficiaries typically pay 20% of the approved amount of the service, except laboratory tests. There’s no yearly limit for what a beneficiary pays out-of-pocket tho
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Cardiovascular Disease Risk Reduction

Cardiovascular disease generally refers to conditions that can lead to a heart attack or stroke. Cardiovascular disease risk reduction visits can help detect and prevent this disease. How to know if I am Eligible? Medicare   Part B  covers an annual cardiovascular disease risk reduction visit with your primary care  provider . You do not need to show any signs or symptoms of cardiovascular disease to qualify for screening, but you must be considered competent and alert when counseling is provided.  During the screening, your provider may; Encourage aspirin use if the benefits outweigh the risks You are a man  of age 45-79 Or a woman of age 55-79 Screen for high blood pressure if you are age 18+ Provide behavioral counseling and tips to encourage a healthy diet Note: Men under 45 and women under 55 are not encouraged to use aspirin as a tool to reduce cardiovascular disease. How much will it cost? If you are eligible,  Original Medicare  will cover your cardiovascular disease risk red
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Lifetime Reserve Days

There are  90 days of  inpatient  hospital care coverage on Original Medicare for each  benefit period , In addition, you also have an additional 60 days of coverag e , called LIFETIME RESERVE DAYS .   These Lifetime Reserved Days  can be used only ONCE, and you will pay a  coinsurance  for each of it. To have a better understanding of it, let’s imagine an individual who had a 120-day  Medicare -covered inpatient stay, this means that they used 30 lifetime reserve days. After they have been out of the hospital for 60 days in a row, they will be eligible for another 90 days of hospital coverage because they will be in a new  benefit period . However, if they need  inpatient care  beyond the benefit period maximum, they will only have 30 of their 60 lifetime reserve days remaining. The above example illustrates that lifetime reserve days do not have to be applied to the same hospital stay. If you need to stay in the hospital twice for 120 days each time during different benefit
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