5-Star Special Enrollment
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Medicare uses information from member satisfaction surveys, plans, and health care providers to give overall performance star ratings to plans.
A plan can get a rating between 1 and 5 stars. A 5-star rating is considered excellent. These ratings are designed to help you compare plans based on quality and performance.
NOTE: You can only switch to a 5-star Medicare Advantage Plan, Medicare Cost Plan, or Medicare Prescription Drug Plan one time before November 30 each year.
If you move from a Medicare Advantage Plan that includes prescription drug coverage to a stand-alone Medicare Prescription Drug Plan, you’ll be disenrolled from your Medicare Advantage Plan, including the health benefit. You’ll be returned to Original Medicare for coverage of your health services. You can only switch to a 5-star Medicare Prescription Drug Plan if one is available in your area.
If you move from a Medicare Advantage Plan that has drug coverage to a 5‑star Medicare Advantage Plan that doesn’t, you may lose your prescription drug coverage. You’ll have to wait until your next enrollment opportunity to get drug coverage, and you may have to pay a Part D late enrollment penalty.
5-star plans are identified with this special icon: 
How to compare plans using the Medicare Star Rating System
Part D drug plans and Medicare Advantage Plans vary greatly in terms of costs and coverage. Each year plans can change their coverage and costs for the new calendar year. This means that every year you should review your plan’s coverage and compare it with other plans in your area to make sure you have the coverage that is best for you.
If you’re working with an agent you can ask them to help you review your options. If you are doing it alone then you’ll have to examine each new plan’s coverage, costs, drug coverage, and the pharmacies in its network to see if it best meets your current needs.
After considering all these important factors to narrow down your choices, you can use the plan’s star rating from Medicare to help you make a final decision.
Medicare Advantage Plans are rated on how well they perform in five different categories:
- Staying healthy: screenings, tests, and vaccines
- Managing chronic (long-term) conditions
- Plan responsiveness and care
- Member complaints, problems getting services, and choosing to leave the plan
- Health plan customer service
Part D plans are rated on how well they perform in four different categories:
- Drug plan customer service
- Member complaints, problems getting services, and choosing to leave the plan
- Member experience with the drug plan
- Drug pricing and patient safety
REMEMBER: Before you consider a plan’s star rating, make sure the plan’s coverage and costs suit your needs. For example, if you are considering a Part D plan, be sure the new plan covers your drugs at a cost that works for you.
Where can I find information on my plan’s star rating?
Star ratings can be found using Medicare’s Plan Finder tool or by calling 1-800-MEDICARE. New plan quality ratings come out each October and apply to the next calendar year (for example, plan ratings for 2021 will be available in November 2020).
How can I use the star ratings to inform my plan choice next year?
You can use star ratings to compare plans in your service area by the categories listed above that Medicare finds important indicators of the insurance company’s performance. Remember that a plan’s star rating is only one factor to look at when comparing plans. Even though a plan has a high star rating, it may not be right for you. You should also consider the plan’s costs, coverage, and network for providers and pharmacies.
Be careful of low rated plans.
If Medicare gives a plan fewer than three stars for three years in a row, It will be flagged as as low-performing. The symbol Medicare uses to show that a plan is low-performing is an upside-down red triangle with an exclamation point inside of it (similar to a caution sign).
Medicare will notify you if the plan you are enrolled in is flagged as low-performing. You will not be removed from the plan, but you may want to check the plan’s costs and coverage to make sure it is still a good plan for you.
What is the Five-Star Special Enrollment Period?
Generally, you can only change your plan or enroll in a new plan during specific times. Special Enrollment Periods (SEP) are periods of time outside normal enrollment periods, triggered by specific circumstances.
If you want to enroll in a plan or change plans, you can take advantage of an SEP to join or switch to a five-star Medicare Advantage or Part D plan. This means that you can enroll in a Medicare Advantage Plan or stand-alone Part D plan in your service area that has an overall plan performance rating of five stars. You may only use this SEP once per calendar year.
- This SEP begins December 8 of the year before the plan is considered a five-star plan (remember that ratings come out in November) and lasts through November 30 of the year the plan is a five-star plan
- Enrollments in December are effective January 1
- Enrollments from January to November are effective the month following the enrollment request
Want to know more?
If you would like to talk to me or schedule a meeting, you can reach me at 207-370-0143 or use the simple form below to send an email message.
The best part about working with me is that it will not cost you anything to discuss your options or to review the plans that are available. I am paid by the insurance companies in the form of a commission if you enroll in a plan. Just like your car insurance agent!
I will help you shop around to find the plan with the best price and the most benefits. My goal is to help you and I have found great joy in being able to offer my services to people who need my help.Shortcode
If you are turning 65 this year or retiring, you may have questions.
Call me today and I will be happy to explain all your options and help you compare plans so you can choose the coverage you need for a price you can afford.
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