Value-based care in Medicare Advantage Plans

In our last post, we discussed the shift in the healthcare industry from fee-for-service to value-based care. However, Medicare advantage plans oriented toward value-based care do already exist. This is manifested through what are known as ‘star ratings’ of plans. Medicare Advantage Plans and Part D Plans are scored by Medicare on how they perform in various categories. These ratings are reviewed yearly, and they can provide a good reference for those comparing plans.

The presence of these star ratings represents a direct incentive for insurance companies to provide better care. With plans rated in categories such as member experience, managing chronic conditions, plan responsiveness, and more, it is easy to see how companies would benefit from maintaining the quality of their plans each year. However, these star ratings are not only a tool for the Medicare consumer. They are also a tool used by the federal government for reimbursements to insurance companies. Consequently, the plans with a higher star rating can offer a more generous benefit structure. This reimbursement system can be considered a form of value-based care since companies are being directly reimbursed based on patient outcomes. This can make MAPD’s (Medicare Advantage Prescription Drug plans) a very cost-effective option for the consumer.

The Treasure Valley is a very competitive marketplace, so we have many Medicare Advantage plan options–many of which have very rich benefits. Some may be concerned that Medicare Advantage plans have a restrictive network of coverage. While this may have been somewhat true in the past, the landscape has changed in 2020, and we have great plan options now offering wide networks not only in Idaho but also nationwide.

Have any questions? Feel free to call Elise at (208)918-0201 or email her at

(Source for a general overview)