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Medicare 5-Star Special Election Period

October 6, 2016

The Medicare 5-Star Special Election Period (SEP) is when you may switch to a 5-star-rated Medicare Advantage plan, stand-alone Medicare Prescription Drug Plan, or Medicare Cost Plan. Medicare uses a star rating system to help consumers compare quality and performance across different Medicare plans.

Medicare plan ratings

Medicare star ratings apply to the plan types listed above. Each plan is rated on a scale of 1 to 5 stars, using survey information from Medicare plans, plan members, and providers. A 5-star rating is considered “Excellent,” while a 1-star rating is “Poor.” Medicare rates the plans in individual categories, and gives each plan a single, overall summary star rating. For plans covering health services, the rating covers 36 different topics in five categories, while for plans covering prescription drug services, the rating covers 15 different topics in four categories. The star rating displayed when you shop and compare Medicare Advantage plans is the summary star rating, and gives you a quick way to judge a plan’s quality.

Medicare Advantage plans are assessed for a variety of factors, including member satisfaction, customer service, whether members received needed services and preventive care, and more. If the plan covers prescription drug benefits, the plan is also rated on accuracy of prescription drug pricing information and patient safety.

Medicare plan star ratings can change from year to year. It is important to always check your plan’s star rating as you consider your coverage options for the coming year.

The 5-Star Special Election Period (SEP)

While you can enroll in a Medicare Advantage plan or a stand-alone Medicare Part D Prescription Drug Plan during your Initial Enrollment Period and the Annual Election Period, the Medicare 5-Star Special Election Period is a special opportunity for beneficiaries to switch to a 5-star-rated plan. The 5-Star SEP takes place annually from December 8 to November 30 of the following year. Plan coverage typically begins the first day of the following month after the plan receives your application; this is known as your coverage “effective date.”

Medicare updates its plan star ratings every fall. This can affect which plans you can sign up for. For example, if a Medicare Advantage plan has a 5-star rating for the current year, but loses a star for the following year, you can only use the 5-Star SEP to enroll in this plan up until November 30, for an effective date beginning December 1. You wouldn’t be able to enroll in the plan after December 1 (for an effective date of January 1 the following year), since the plan doesn’t have a 5-star rating for the next year.

During the 5-Star Special Election Period, you can only switch to a 5-star rated Medicare plan one time. During this enrollment, you can:

  • Dis-enroll from Original Medicare (Part A and B) and enroll in a 5-star rated Medicare Advantage plan.
  • Switch from a Medicare Advantage plan (with or without prescription drug coverage) to a 5-star rated Medicare Advantage plan (with or without prescription drug coverage).
  • Switch from a stand-alone Medicare Part D Prescription Drug Plan to a 5-star rated stand-alone Medicare Part D Prescription Drug P
  • Switch from a 5-star rated Medicare Advantage plan to a different 5-star rated Medicare Advantage plan.
  • Switch from a 5-star rated Medicare Advantage Prescription Drug plan to a different 5-star rated Medicare Advantage Prescription Drug p
  • Dis-enroll from a Medicare Advantage or Medicare Prescription Drug Plan and enroll in a 5-star rated Medicare Cost Plan.*

*Medicare Cost Plans are a type of Medicare health plan that is different from Medicare Advantage. You can sign up even if you only have Part B. Some plans include prescription drug coverage, while others only cover Part B benefits. You can check with the individual insurance company for more information.

Consider your changes carefully

When deciding whether to switch plans during the 5-Star Special Election Period, carefully consider the consequences. Here are some Medicare plan rules that still apply to this election period:

  • If you switch from a Medicare Advantage plan that includes prescription drug coverage (a Medicare Advantage Prescription Drug plan) to a 5-star Medicare Advantage plan that doesn’t include prescription drug coverage, you may have to wait until the next Annual Election Period to enroll in Medicare Part D. You could pay a Medicare Part D penalty unless you have other creditable prescription drug coverage.
  • If you have a Medicare Advantage plan that includes prescription drug coverage (a Medicare Advantage Prescription Drug plan) and enroll in a stand-alone Medicare Part D Prescription Drug Plan, you’ll be automatically dis-enrolled from Medicare Advantage and returned to Original Medicare. You usually won’t have a stand-alone Medicare Prescription Drug Plan if you have Medicare Advantage, unless you have a Medical Savings Account plan or a Private Fee-for-Service plan.

5-Star SEP eligibility

Generally, you can switch to a 5-star Medicare Advantage plan, stand-alone Medicare Part D Prescription Drug Plan, or Medicare Cost Plan as long as you meet the eligibility requirements. Eligibility criteria include:

  • Having Medicare Part A and Part B, if you want to switch to a Medicare Advantage plan or remain with Original Medicare and enroll in a stand-alone Medicare Part D Prescription Drug Plan.
  • Having at least Part B if you want to switch to a Medicare Cost Plan.
  • Living in the service area of the plan you want to enroll in.