According to the Kaiser Family Foundation, Medicare Advantage plans with high quality ratings are clustered in certain states, leaving beneficiaries in a handful of states with few, if any, options for choosing a highly rated plan.
Further, a Kaiser analysis found that states with a higher percentage of Medicare enrollees and higher enrollment were rated higher on average, which makes them likely to receive more bonuses and quality-based payments starting in 2012, when the new health reform law requires Medicare to begin rewarding highly-rated Medicare plans.
The Centers for Medicare & Medicaid Services rates plans on a five-star scale, with five stars representing the highest quality; plans with a rating of four stars or more will qualify to receive Medicare bonuses in 2012.
According to the analysis, roughly one in four Medicare Advantage enrollees (24 percent) are enrolled in plans with four or more stars, while 46 percent are in enrolled in plans rated with three stars or less.
Access to highly-rated plans is difficult and in some cases impossible in a number of states. The Kaiser analysis, titled "2010 Medicare Health Plan Quality and Performance Ratings" and released in March, indicated that Vermont, Mississippi, Nebraska, Montana and Alaska have no enrollees in plans with four stars or more.
In 27 states, fewer than 10 percent of Medicare Advantage enrollees are in plans with four or more stars – including three states (Nevada, Delaware and Florida) where the vast majority of beneficiaries have access to at least one highly rated plan.
Similar variations exist at the county level, with more than one-third of beneficiaries (37 percent) living in counties without access to any Medicare Advantage plan with a high quality rating of at least four stars.
Even in counties where four-star plans are available, enrollment varies. For example, more than 80 percent of enrollees in Hennepin, Minn. (which includes Minneapolis) are in plans with four or more stars, but less than 1 percent of enrollees in Clark County, Nev. (which includes Las Vegas) and Cook County, Ill. (which includes Chicago) are in plans receiving four or more stars.
Some beneficiaries aren't enrolled in plans with high quality ratings because they select their plan based on factors unrelated to the plan rating, such as the plan's premium, additional benefits or whether their physician is included in the plan's network.
Also, it's not clear how many beneficiaries use Medicare.gov to select their Medicare Advantage plan, and thus many may not know how their plan rated relative to others in the area. Other beneficiaries live in areas in which all plans received either average or low quality ratings.