Star ratings for Medicare Advantage plans are an easy way to know if you are enrolling in a plan that offers excellent healthcare and customer service. Medicare Advantage (or Part C) plans are rated from one to five stars, with the 5-star Medicare plans earning the highest “excellent” rating.
But what exactly does that mean? What’s so special about these plans? This article will explain more about 5-star Medicare Advantage plans and the special enrollment period available.
What does a 5-star Medicare plan rating mean?
As we mentioned, a 5-star rating means the plan offers excellent health benefits and the insurance carrier has excellent customer service. To compare, this list of ratings tells you what each one means.
- 1 Star = Poor
- 2 Stars = Below Average
- 3 Stars = Average
- 4 Stars = Above Average
- 5 Stars = Excellent
Many Medicare Advantage plans include prescription drug coverage. If the plan being rated is given five stars, it also means that the drug formulary within the plan offers safe prescriptions at fair prices.
How are Medicare Advantage plans rated?
The Centers for Medicare & Medicaid Services (CMS) does not hand out ratings without a rigorous review process. CMS has many quality and performance categories, and each plan must meet certain standards in each of those categories.
CMS also considers member surveys, monitoring by the Medicare program, information submitted by plans and healthcare providers, and billing information for prescription drug coverage. Medicare Advantage Plans with Prescription Drug coverage are rated on up to 38 unique quality and performance measures. These ratings are updated annually and posted for consumer viewing every fall.
Special Enrollment Periods for 5 Star Medicare Advantage Plans
The period when everyone can make a change to their Medicare enrollment options is during Medicare’s Annual Election Period (AEP) from October 15th to December 7th. This is when you can add, change, or drop a Medicare Advantage or Part D Prescription Drug plan. Outside of AEP, you must qualify for a Special Election Period (SEP) if you want to make a change.
Luckily, there is a Special Enrollment Period (SEP) for anyone who lives in an area with a 5-star Medicare Advantage plan. If a Medicare Advantage plan with a 5-star rating is in your area of service, you can make a change outside of the Annual Election Period if you choose to add or change to a 5-star plan. You can add the 5-star plan even if you don’t currently have a Medicare Advantage plan and have Original Medicare. This Special Enrollment Period is available from December 8 to November 30. You may make a ONE-TIME change to a 5-star plan during this time. However, you can only use the SEP for 5-star plans once per calendar year.
EXAMPLE:
Jon Smith currently has an MAPD plan, but he received a postcard about a different 5-star plan in his area. He wonders if he can make a change to the 5-star plan outside the annual election period. Since the new plan has received an overall rating of 5-stars, Jon can use the Special Election Period for 5-star plans to change now.
Not sure if there are any 5-star plans in your area? Our licensed agents can help you look up plans. Contact a friendly, licensed agent HERE.
