Beneficiaries eligible for Medicare can take advantage of a special enrollment period if there is a plan in your service area that has been awarded a rating of five stars. To make this change, Medicare beneficiaries must currently be enrolled in one of the following:
- Prescription Drug Plan (PDP)
- Medicare Advantage Prescription Drug (MAPD) Plan
- Medicare Advantage (MA) Plan with no drug coverage
- Not enrolled in any plan
If there is more than one five-star plan in your service area, it's possible to switch from one of these plans to another. This special enrollment opportunity can be used once between December 8th and November 30th. Enrollment changes are effective the first day of the month following the month you submit your enrollment request.
There are risks involved in making this change. The key is that you understand the benefits of the plan that you currently have, and the benefits of the five-star plan that you may be considering. Consideration must also be given to any network changes, formulary changes and benefits of the new plan chosen. It is possible to lose your prescription drug coverage if you unintentionally join a five-star Medicare Advantage Plan that does not include prescription drug coverage. In this case, you would have to wait until the next Open Enrollment Period (October 15 - Dece mber 7) to join a drug plan. The new plan would be effective January 1st. You might have to pay a late enrollment penalty for being without Part D drug coverage.
The star ratings of Medicare plans are awarded to plans based on member satisfaction surveys and health care provider comments. The rating system for Medicare Advantage Plans uses five key criteria in their assessment. These criteria help evaluate member access to preventive services; how often members receive treatment for long-term health conditions; overall satisfaction; number and type of complaints against the plan; quality of customer service. The ratings range from 1 to 5 stars, with 5 stars considered excellent. Medicare updates these ratings annually. The ratings can change from year to year.
If the Centers for Medicare and Medicaid Services notifies you that your current PDP or MAPD has failed to achieve at least a 3-star rating for three years straight, you may switch to any 4- or 5-star plan. The switch can be made any time during the year following notification and at any time the following year. This switch must go through 1-800-MEDICARE.
Medigap plans are not included in the five-star Medicare rating system. These plans are rated, but with different criteria, mostly dealing with financial stability; and by different agencies. There are several independent rating agencies, such as, A.M Best Company and Standard and Poor’s Insurance Rating Services. These rating agencies use letter grades to indicate a company’s financial stability. The letters A++ or A+ show a superior financial rating for the company.