How to Take Advantage of 5-Star Special Enrollment Period

Medicare Advantage Plans and Medicare Prescription Drug Plans receive a star rating based on several factors to help Medicare enrollees find the best plan to fit their needs. If you don’t have a 5-star plan and are eligible to enroll in a Medicare plan, then you may be able to switch to one during a 5-Star Special Enrollment Period.  

Below we break down how plans get the top rating, when the special enrollment period is and how you can change your plan.  

What is the 5-Star Rating Scale?

Medicare Advantage Plans and Medicare Prescription Drug Plans receive a star rating based on several performance metrics. These ratings are intended to help Medicare enrollees make a better decision when comparing available plans.  

The plans are rated on a scale of 1 to 5 stars. A 1-star rating classifies the plan as “poor,” a 3-star plan is considered “average” and a 5-star plan represents an excellent plan.   

Medicare updates the star rankings for each plan in the fall for the following year, usually before the Medicare Annual Enrollment Period (AEP). 

How are Plans Rated?

Each year, the Centers for Medicare and Medicaid (CMS) publishes the Medicare Advantage and Medicare Prescription Drug Plan Star Ratings to help enrollees make more informed choices about their healthcare plan.  

Medicare Advantage Plans with and without prescription drug coverage and stand-alone Medicare Prescription Drug Plans are rated on several unique quality and performance measures. Some of the measures include assessing clinical recommendations and feedback received from stakeholders.i  

Medicare Advantage Plans with and without prescription drug coverage are rated on 28 measures and stand-alone prescription drug plans are rated on 12 measures.  

Once CMS gathers the feedback and data from the stakeholders and evaluates how well each plan does at giving the enrollee what they need, CMS publishes the updated list of ratings.

When is the 5-Star Special Enrollment Period?

Almost all year. If a Medicare Advantage Plan, with or without prescription drug coverage, or a stand-alone Medicare Prescription Drug Plan with a 5-star rating is available in your area, you can use the 5-star special enrollment period to switch to the top-level plan.  

You can use the 5-star special enrollment period once between Dec. 8 through Nov. 30.ⁱⁱ   

It’s important to note that if you switch from your current Medicare plan to a 5-star plan different from what you had, you may lose some of your health care benefits. For example, suppose you switch from a 4-star MA plan with drug coverage to a 5-star MA plan without drug coverage. In that case, you may no longer have prescription drug coverage. If you decide that you want prescription drug coverage again, then you’ll have to wait until your next enrollment period to make a change.  

How Many 5-Star Plans are Available?

In October 2021, the Centers for Medicare and Medicaid Services (CMS) revealed their ratings for the 2022 Medicare Advantage and Medicare Prescription Drug Plans. In 2022, just under 16 percent of all Medicare Advantage Plans with prescription drug coverage will have a 5-star rating.ⁱⁱⁱ  

In the same CMS announcement, 68 percent of Medicare Advantage Plans with prescription drug coverage will have a 4-star rating or higher in 2022 – up from 49 percent in 2021.^iv

For stand-alone Medicare Prescription Drug Plans, just over 18.5 percent of plans available have a 5-star rating and 54 percent of plans have a 4-star rating or higher. 

This increase in the overall star rating increase indicates that more insurance providers are offering plans that meet the needs of Medicare beneficiaries.

Do You Want to Switch to a 5-Star Plan?

If your Medicare Advantage Plan or Prescription Drug Plan has a rating below 5 stars and you want to see if one is available, then Ensurem is here to help. Ensurem’s team of licensed insurance agents can look to see if there are any 5-star Medicare Advantage Plans or Medicare Prescription Drug Plans available in your area.  

If you do decide to switch plans using your 5-Star Special Enrollment Period, your Ensurem agent will enroll you in the plan over the phone. 

If you prefer comparing plans at your own pace, Emma is here. Emma – your virtual Medicare assistant – will help you shop for any 5-star plans available in your area with no need to speak to an agent, all from the comfort of home.  

Give Ensurem a call using the phone number on this page or enroll online with Emma to help you get a 5-star plan.

Ready to Talk to an Expert but Don’t Know What to Say? Here is a List of Questions you can Ask to Help Get You Started.

• Who qualifies as Medicare beneficiaries?
• When is the annual open enrollment period for Medicare?
• What kind of drug coverage does Medicare provide?
• Can you explain the different prescription drug plans available under Medicare?
• What is the enrollment period for Original Medicare?
• What is a Medicare contract and how does it affect me as a beneficiary?
• How do star ratings affect my choice of Medicare plans?
• Are all Medicare beneficiaries eligible for every plan?
• What is the Quality Bonus Payment Demonstration in relation to Medicare?
• How do Medicare plan ratings affect my choice of coverage?
• How do Medicare Star Ratings impact the quality of care I receive?
• Can you explain the different parts of Medicare?
• What does CMS’s statutory authority mean for my Medicare coverage?
• Can I change my Medicare plan outside of the annual enrollment period?
• How do I submit an enrollment request for a new Medicare plan?
• What benefits are available to plan members under Medicare Supplement plans?
• How important is the summary quality star rating when choosing a Medicare plan?

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