This article is intended for our Insurance Carrier Partners
As Medicare Advantage (MA) plans navigate increasingly stringent performance metrics, one often-underutilized strategy is proving to deliver real impact: the annual eye exam.
Beyond vision correction, routine eye care plays a critical role in chronic disease management, especially for seniors with diabetes. A recent whitepaper from EyeMed explores how this single measure can help MA plans close care gaps, improve outcomes—and strengthen Star Ratings.
Star Ratings are getting tougher
The Centers for Medicare & Medicaid Services (CMS) has revised its evaluation criteria, leading to a notable dip in average Star Ratings—from 4.37 in 2022 to 3.92 in 2025 for MA Prescription Drug contracts.1 For health plans, this trend signals the need to double down on performance-driving quality measures.
Why eye exams matter
The eye exam measure, which tracks whether diabetic enrollees receive an annual retinal or dilated exam, is a key part of the Healthcare Effectiveness Data and Information Set (HEDIS). It’s also a high-impact opportunity for improving both patient health and Star Ratings. Over 29% of the U.S. population aged 65+ has diabetes, making early detection of conditions like diabetic retinopathy critical to member outcomes and plan performance.2
Proven impact from targeted outreach
In a 2024 program managed by EyeMed, diabetic members who received targeted outreach closed the eye exam gap at a 17.6% higher rate than those who didn’t.3 EyeMed helped close more than 230,000 diabetic eye exam gaps across its plan partners—achieving a 38% closure rate.3
Strategies for improvement
There are several proven tactics to drive results:
- Member education & engagement: Personalized reminders, educational materials, and workshops to increase compliance.
- Provider collaboration: Stronger care coordination and simplified referral workflows.
- Advanced analytics: Data-driven identification and follow-up with members due for exams.
- Incentives: Rewarding members for completing annual eye exams.
With robust digital and provider-facing tools, these strategies can be customized to fit each plan’s goals.
Beyond compliance: Member satisfaction and bonus potential
Improving compliance with clinical care measures like the eye exam doesn't just improve ratings—it also enhances member satisfaction and impacts bonus payment eligibility. In a shifting regulatory landscape, investing in vision care is a smart move for MA plans seeking a competitive edge.
Ready to take action?
To learn how EyeMed can tailor a quality program to your plan’s needs, reach out to your account representative.
Download the whitepaper: Mitigating Challenges and Driving Results: How Annual Eye Exams Support Star Ratings for Medicare Advantage Plans
Watch our recent webinar with EyeMed's MA experts.
1“Medicare Advantage Star Ratings Drop Again;” MedCity News; October 2024.
2 “Statistics About Diabetes;” American Diabetes Association; November 2023.
3 EyeMed Internal Results, 2024.
