What You Need to Know About the Special Enrollment Period for 5-Star Medicare Plans

Each year the Center for Medicare and Medicaid Services (CMS) releases quality ratings for each carrier offering Medicare Advantage and Part D plans. Plans are rated 1-5 stars based on factors such as member experience, customer service, plan performance, management of chronic conditions and well-care considerations such as screening tests, vaccines and check-ups. A 5-star rating is considered “excellent.”

Medicare plan participants have the opportunity to switch to a 5-star rated plan during a Special Enrollment Period (SEP) outside of the typical annual enrollment window. This is a good opportunity for someone on a Medicare Supplement or “MediGap” plan to review their situation. For those already on a Medicare Advantage plan, it’s a good opportunity to make a change if they are unsatisfied with their current plan. 

Enrollees can use this SEP to change to a 5-star plan once a year between now and November 30, 2023.

 A few important things to keep in mind:

• This SEP can be used to move from a lower star plan OR from a 5-star plan to a new 5-star plan.
• Medicare Supplement clients can move using this SEP as long as they enroll in a Medicare Advantage-only or a Medicare Advantage with Part D plan, even if coming from Original Medicare (with or without concurrent enrollment in a Part D Plan).
• The 5-star SEP continues until November 30 and the effective date for a new plan is the first of the month following application date.

In short, the 5-star SEP provides a great time for a review, and an opportunity to possibly change to a plan that Medicare rates as “excellent.” That said, as with all things related to Medicare, things can get tricky. Please feel free to reach out me with any questions or to set up a time to review in more detail.