ACHP: Nonprofit Medicare Advantage plans made up one-third of 5-star options

Nonprofit community Medicare Advantage (MA) insurers touted more five-star plans compared to their competitors, according to a new analysis. 

The analysis, released Thursday from the Alliance for Community Health Plans (ACHP), which represent nonprofit plans, showed that nearly one-third of all five-star plans belonged to an ACHP member. The scores come as plans with four or more-star ratings declined overall. 

“These scores are a result of community health plans’ unique approach to coverage and care,” said ACHP President and CEO Ceci Connolly in a statement. “When payers and providers work together, they’re able to focus on consumer needs—ensuring better health outcomes and an overall better care experience.”

ACHP showed that 31.6% of all five-star ratings were offered by an ACHP member, such as UPMC Health Plan and Kaiser Permanente. 

“In addition to leading on overall scores, ACHP member companies excelled in key metrics—both in clinical measures and consumer experience,” according to a release on the findings. “On average, ACHP member plans outscored the competition on 45 out of 50 measures, including managing chronic conditions, customer service and rating of health plan.”

The findings come as star ratings overall declined for plans for the 2023 coverage year. New data from the Centers for Medicare & Medicaid Services (CMS) showed that 51% of 2023 MA plans offering drug coverage have four or more stars, compared with 68% for plans this year.

A major driver for the decline is CMS phasing out a COVID-19 “disaster provision” to help plans weather financial pressures caused by the pandemic. The provision enabled plans to pick the best score on 28 quality and performance measures for 2022-star ratings. 

Consumers use star ratings to compare health plans during open enrollment, which runs through Dec. 7. The higher the star rating, the greater the bonus payment given to the plan. 

Nonprofits make up a smaller percentage of MA plans, with major players such as Humana and UnitedHealthcare making up more than 50% of all plans in 2022, according to an analysis from the Kaiser Family Foundation.