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No FL Medicare plan wins top rating

Florida's only Medicare plan to earn top billing in government ratings the past two years has slipped a bit, according to new ratings the government released Wednesday.

Capital Health Plan dropped from a five-star rating to four stars.

The slip was due to lowered scores for its Part D (prescription drug) plan, said Capital Health spokeswoman Maggie Callan.

A statement from Capital's CEO John Hogan does not mention the slip and says that "Capital's health plan continues to be the highest in Florida" and "has not changed."

Only nine plans nationally earned five stars--none were in Florida.

The ratings, which use nearly 40 measures to rank the country's 569 private Medicare plans from one to five stars, are extra competitive this year as plans vie for a piece of the $3 to $4 billion in bonuses available through the Affordable Care Act.

The bonuses—which range from 3 to 5 percent of the company's total Medicare payments-- are only available for Medicare Advantage plans.

Bonuses are required to be used for extra benefits for the plans' beneficiaries, and should give those plans a competitive advantage with consumers, said Gretchen Jacobson, of the Kaiser Family Foundation.

Medicare's standalone Part D plans receive ratings but are not eligible for bonuses.

For the first time, five-star plans this year can advertise and recruit customers all year instead of just during the annual enrollment period that will run from Oct. 15 to Dec. 7.

"We hope people with Medicare will consider the ratings during the Annual Election Period that begins Saturday so they will generally move to higher quality plans," said Centers for Medicare and Medicaid spokesman Robert Foster. "We have already seen (in 2011) greater enrollment among Medicare Advantage plans with a higher star rating, so we are hopeful the trend will continue."

The ratings are determined through nearly 40 measures, from customer care to the cost of prescription drugs, according to the Medicare website.

Larry Polivka, a Medicare expert at the Claude Pepper Foundation in Tallahassee, said the ratings were interesting but not shocking and that seniors should look at the specific measures and not just the overall ratings.

For instance, Plan Finder shows that Capital scored only two stars in mental health care.

In last year's measures, Capital Health Plan scored high in most areas, but received only one star in specialty care, he said.

"One of the biggest concerns people have about choosing an HMO is whether they'll be able to go to the right doctor when they need to," he said. "People should look at those specific measures."

He added that the categories used by CMS are good but incomplete.

“It would be impossible to assess everything about a plan,” he said.

Andrea Gary, who helps seniors navigate Medicare enrollment through the Florida SHINEprogram said she encourages people to use far more than the ratings when determining plans.

“Cost, coverage, convenience and customer service will probably be the best determinates for a good fit,” she said.

---Health News Florida is an independent online publication dedicated to public-service journalism. Reporter Brittany Alana Davis can be reached at 954-239-8968 or by e-mail.