5 Star Special Enrollment Period
A 5 star special enrollment period is available if a MAPD, PDP or Cost Plan with a 5-star rating is available in the service area. The special enrollment period (SEP) is available on a one time basis between December 8th and November 30th. Be sure to check current ratings!
5 Star Special Enrollment Period: How does a plan get a 5 star rating?
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 help you compare plans based on quality and performance. Medicare updates these ratings each fall for the following year. These ratings can change each year. Medicare star rating system
The number of unique quality and performance measures change with plan type: Medicare uses 53 criteria for star ratings but they do not use all 52 toward each plan type. Part C and D star rating fact sheet
- MAPD: 38 Quality and performance measures
- MA: 28
- PDP: 12
Plan Changes with the 5 star SEP?
You can move to a 5 star Medicare Advantage plan as long as you have Medicare A and B. A move is alloed to a 5 star stand alone drug plan as long as you have Medicare Part A. Enrolling in a 5 star drug plan will automatically cancel any current PDP, MA, or MAPD in place. Enrolling in a 5 star MA, MAPD or will cancel any existing MA, MAPD or PDP in place. Keep in mind, if someone moves from an MAPD to an MA only plan, they will no longer have drug coverage. A stand alone PDP are not allowed with an MA plan.
Check plans eligible for a 5 star special enrollment period:
There is a list of all the 5 star plans avaialble for 2022 on the CMS site. CLICK HERE FOR INFORMATION
Check for 5 star plans on Connecture and Sunfire
Agents can use Connecture and Sunfire to search for 5 star MAPD and PDP plan in their area. Both platforms show the star ratings for each company. Sunfire also has a filter to see only 5 star rated plans.