But if beneficiaries insist on staying in a low-rated plan, they eventually could be forced out.  The notices do not explain that the plans may be in serious trouble.  In April, the Centers for Medicare and Medicaid Services, which oversees Medicare, warned insurers that plans rating less than three stars over three years "have ignored their obligation to meet program requirements and [are] substantially out of compliance with their Medicare contracts over a period of time."

Such plans can expect greater scrutiny, the letter continues, beginning with notices to beneficiaries alerting them to their plans' low ratings. "They should also expect CMS to initiate action to terminate their contract" after CMS confirms that the consistently low scores reflect violations of Medicare rules. In October, CMS prohibited one of the 26 plans from enrolling new members.

Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, an industry trade group, said the letter to beneficiaries is "premature" because the ratings system is flawed.  It is based on measures that do not sufficiently take into account, for example, plans serving a disproportionate number of beneficiaries with multiple chronic conditions or special needs, or who live in medically underserved areas.  "These are unique challenges to providing care to those populations," he said.

"It’s important to make sure we get the measures right before we move on to these other steps," he said.

Leslie Fried, director for policy and programs at the National Council on Aging, a Washington, D.C., advocacy group, said the letter didn’t have to mention potential plan terminations. "The letter tells people what they need to know about the quality of their plan and that they should consider changing to a higher performing plan," she said.  "It’s an important first step."

And if seniors ignore the warning, that’s their choice, she said.  "If people are satisfied with their plan and it is currently contracted with CMS, isn’t that a decision they should be allowed to make?" 

Susan Jaffe can be reached at Jaffe.KHN@gmail.com.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

Editor's Note:
If you are a subscriber to Consumer Reports you can access ratings by state to healthcare plans:

Health-Insurance Plan Rankings from the NCQA

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