Just in time for Medicare's open enrollment season, a Florida-based HMO has won the federal government's coveted five-star rating, a rare honor that brings more than bragging rights. Such plans receive the freedom to enroll new members all year long.
The winner, CarePlus Health Plans Inc., is a subsidiary of Humana Inc., Florida's largest Medicare vendor. Humana did well in the quality ratings, too, but was outscored by the little plan it bought in 2005.
CarePlus, based in Doral in Miami-Dade County, has plans in 19 counties around the state. Its major markets are South Florida, Tampa Bay, Central Florida, Space Coast and Jacksonville (map).
"We're super-excited here at CarePlus," said Regional President David Jarboe in a phone interview after the star ratings were posted on Medicare.gov Thursday afternoon. "We're very grateful to our 95,000 members for helping us achieve this, and of course our physicians."
The ratings are based on a combination of measures developed by public and private agencies. Some involve provision of preventive health-care services, such as flu vaccine to nearly all members and keeping chronic diseases such as diabetes under control. Other measures are taken from patient opinion surveys.
CarePlus is a mixed-model HMO, with some independent practice physicians and a number of multi-service clinics (See Clinic? Social Club? It's Both). Jarboe said CarePlus has 2,500 primary care physicians treating its members.
CarePlus is the first five-star winner in Florida that is widely available to the state's senior residents. CarePlus' Jarboe said his company was told there were 13 five-star winners for 2015 nationwide, but Health News Florida was unable to get confirmation from the Centers for Medicare and Medicaid Services on Thursday.
Previously, two plans in Florida - Leon Medical Centers in Miami-Dade and Capital Health Plan in Tallahassee -- won five-star ratings, but both were available only in a limited geographic area. This year, those plans score 4 1/2.
The win could propel the comparatively little-known CarePlus into prominence in a state that offers scores of plans -- 88 last year. If it can pull off the five-star feat more than once, it could join managed care royalty, which includes Kaiser Permanente in multiple states and Group Health Cooperative in Washington state.
As part of the Affordable Care Act, the quality-rating system is designed to help consumers gravitate to plans that give the best value for taxpayers' money. Medicare Advantage is set up so that the federal government pays most of the premium; and beneficiaries' share of cost is especially low in Florida.
The state has such a competitive market that many plans charge no premium, including CarePlus' five-star plans and some other companies' plans that won 4 1/2 stars. In fact, in some counties plans with high ratings even reimburse Medicare beneficiaries for some of their Part B monthly premium of $104.90 -- a deal that's almost unheard-of elsewhere in the country.
In past years, Medicare plans could receive rating bonuses if they received three stars, but now the bar has been lifted so that only plans with four stars, "above average," get the extra cash. As an extra incentive, five-star plans can sign up new members all year long, not just during open enrollment.
Not every state has a five-star plan. Only 14 Medicare Advantage companies and five prescription-drug companies won five-star ratings for 2014, Kaiser Health News reported in May.
CMS did not issue a news release about the star ratings on Thursday. But it did post results by the name of each plan on the consumer lookup site, which lists them by zip code.
So in Tampa's 33601 zip code, for example, there are 30 plans, but some companies market several plans with different coverage and premiums. In that zip code, all three of CarePlus' plans were given five-star ratings.
Both Humana and Optimum had 4 1/2-star plans. Humana also had some plans with four stars ("above average"); so did Aetna, Preferred Care Partners and Freedom.
Companies with plans that scored three stars ("average") or 3 1/2 stars were: WellCare, Coventry, Florida Blue, Amerigroup, and AARP UnitedHealthcare. In past years, companies could receive extra payments for hitting three stars, but now that bar has been raised to four.
Only two plans -- Day Break and Sunrise, both from Florida Healthcare Plus, scored below average, according to a search on the website.
--Health News Florida is part of WUSF Public Media. Contact Special Correspondent Carol Gentry at cgentry@wusf.org. For more health news, visit HealthNewsFlorida.org.
