Medicare Health Plan Ratings
The Medicare Program rates how well Medicare health and drug plans perform in different categories (for example, detecting and preventing
illness, ratings from patients, patient safety, drug pricing and customer service). The information provided below is an overall plan rating of our
plan's performance. This information is available to help you make the best choice. If you would like additional information on our plan’s performance
please contact us at 888-252-3153 (toll-free) or 800-735-2929 (TTY/TDD) for prospective members, 866-880-0606
(toll-free) or 800-735-2929 (TTY/TDD) for current members, or you may visit
www.medicare.gov.
Below is a summary of how our plan rated in quality and performance.
| Health Plan of San Mateo - H5428 3.5 Stars |
 |
The Overall Plan Rating combines scores for the types of services each plan offers:
What is Being Measured?
For plans covering health services, the overall score for quality of those services covers 36 different topics in 5 categories:
- Staying healthy: screenings, tests, and vaccines: Includes how often members got various screening tests, vaccines, and other check-ups that
help them stay healthy.
- Managing chronic (long-term) conditions: Includes how often members with different conditions got certain tests and treatments that help them manage their condition.
- Ratings of health plan responsiveness and care: Includes ratings of member satisfaction with the plan.
- Health plan member complaints and appeals: Includes how often members filed a complaint against the plan.
- Health plan telephone customer service: Includes how well the plan handles calls from members.
Download as a PDF
For plans covering drug services, the overall score for quality of those services covers
17 different topics in 4 categories:
- Drug plan customer service: Includes how well the drug plan handles calls and makes decisions about member appeals.
- Drug plan member complaints and Medicare audit findings: Includes how often members filed a complaint about the drug plan.
- Member experience with drug plan: Includes member satisfaction information.
- Drug pricing and patient safety: Includes how well the drug plan prices prescriptions and provides updated information on the Medicare website.
Includes information on how often members with certain medical conditions get prescription drugs that are considered safer and clinically
recommended for their condition.
- For plans covering both health & drug services, the overall score for quality of those services covers all of the 53 topics listed above.
Where does the information for the Overall Plan Rating come from?
For quality of health services, the information comes from sources that include:
- Member surveys done by Medicare
- Information from clinicians
- Information submitted by the plans
- Results from Medicare's regular monitoring activities
For quality of drug services, the information comes from sources that include:
- Results from Medicare's regular monitoring activities
- Reviews of billing and other information that plans submit to Medicare
- Member surveys done by Medicare
Why is the Overall Plan Rating important?
The Overall Plan Rating gives you a single summary score that makes it easy for you to compare plans based on quality and performance. Learn more about
differences among plans by looking at the detailed ratings.
CareAdvantage is a 2012 3.5-Star rated plan. Plan performance summary star ratings information is assessed each year and may change from one year to the next.
H5428_CA_4001_12_EN Pending CMS Approval (Updated 02/22/2012)