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What is a 5-Star Medicare Plan?

There is a Medicare plan, or combination of Medicare plans, out there for pretty much everyone. It’s rare for a plan to be inherently better than another plan, since we all have different wants and needs. That said, there is a group of plans considered the gold-standard for Medicare Advantage or Part D drug plans.

Each year, the Centers for Medicare & Medicaid Services (CMS) evaluates Medicare plans and designates their top plans as 5-star plans. Not only are these the highest-rated plans on the market, but they also come with Special Enrollment Period that you may find quite interesting!

What Does a 5-Star Rating Mean in Medicare?

A 5-star Medicare plan is one that has been rated as excellent by CMS through a number of factors used to evaluate plan quality. Fresh plan ratings are usually released around the start of a new Annual Enrollment Period so that beneficiaries looking to change their plans can get a sense of their options at a glance.

CMS ranks both Medicare Advantage and Medicare Part D plans on a scale of one to five stars. The rating system involves domains and measures, with domains acting as broad categories and measures referring to more specific functions. Medicare Advantage plans are generally rated in five domains:

  • Staying Healthy: Screenings, Tests, and Vaccines
  • Managing Chronic (Long Term) Conditions
  • Member Experience with Health Plan
  • Member Complaints and Changes in Health Plan’s Performance
  • Health Plan Customer Service

Drug plans are usually evaluated in four domains:

  • Drug Plan Customer Service
  • Member Complaints and Changes in Drug Plan’s Performance
  • Member Experience with Drug Plan
  • Drug Safety and Accuracy of Pricing

The number of measures used to evaluate a plan may change each year, but they’ll usually fall under those domains. For example, 2022 Medicare Advantage plans were evaluated using 38 measures, instead of 32 for 2021, but they were rated in the same five domains.

To receive a 5-star rating, a Medicare plan must represent an excellent value for money, quality of product, and customer satisfaction for both the plan coverages and the service offered by the plan providers. Key among any plan that offers coverage for prescription drugs is an evaluation that any drugs covered by the plan are safe and priced accurately for the consumer so that they aren’t unfairly overpaying.

When Can You Enroll in a 5-Star Medicare Plan?

You can enroll in 5-star Medicare plans during your Initial Enrollment Period, the Annual Enrollment Period, or even the Medicare Advantage Open Enrollment Period or a Special Enrollment Period if you qualify. Plans that receive a 5-star rating actually have their own special enrollment window, called the 5-Star Special Enrollment Period (5-Star SEP), which you may be able to use to enroll as well!

You can use the SEP to make a move to a 5-star plan once during this time frame.w

If you’re in an area with an available 5-star Medicare plan, you could try using the 5-star SEP to move to that plan. So, when is this 5-star SEP? It begins December 8 and runs until November 30 the following year. You can use the SEP to make a move to a 5-star plan once during this time frame. To give a more concrete example, you can enroll in a 5-star Medicare plan once between December 8, 2022, and November 30, 2023. The next window will open December 8, 2023, and close November 30, 2024. The reason for this eight-day period where the window is closed is to switch over enrollment to the next plan year. For example, the 2022 window above would allow you to enroll in 2023 5-star plans while the 2023 window would allow access to 2024 plans. You can only move to a 5-star plan once during the SEP, though you can change again during the AEP.

Should I Switch to One of These Plans?

If you move from a Medicare Advantage plan that has drug coverage to a 5-star Medicare Advantage plan that doesn’t have drug coverage, you may lose drug coverage and have to wait until the next possible enrollment period to regain it. You may also be subject to a penalty for the time you didn’t have dug coverage. Furthermore, if you go from a Medicare Advantage Prescription Drug plan to a stand-alone, 5-star Part D prescription drug plan (that doesn’t include Part C Medicare Advantage coverage), you’ll be automatically disenrolled from your Medicare Advantage plan and enrolled in Original Medicare alongside your new Part D plan.

A local licensed insurance agent can help you weigh your options during a no-obligation consultation.

It’s important you consider all the benefits and coverage you get with your current plan and whether you’d get at least the same benefits and coverage with the 5-star plan. Factoring in all cost and network differences is also important. A local licensed insurance agent can help you weigh your options during a no-obligation consultation.

Are There a Lot of 5-Star Plans Available?

The number and percentage of 5-star Medicare plans in the United States is growing. In 2019, there were only 14 5-star Medicare Advantage (3.72 percent of the available plans) and four 5-star Part D plans (7.69 percent of the available plans). Comparatively, in 2022, there were 74 5-star Medicare Advantage plans (15.71 percent of the available plans) and 10 5-star Part D plans (18.52 percent of the available plans). From 2019 to 2022, the average star rating has also grown from 4.06 to 4.37 for Medicare Advantage plans and 3.34 to 3.70 for Part D plans.

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Five-star plans are held up as the highest-rated plans that Medicare has to offer, and each year, there are more available to potential enrollees. If you have one available to you, you also have a large window of time where you can enroll in a 5-star Medicare plan. If you don’t have a 5-Star plan available to you, don’t worry; your likelihood of finding a high-quality plan may be growing, as data shows that the overall quality of Medicare plans is growing!

If you’re interested in seeing which plans are available in your area, including 5-star Medicare plans, check out the Medicareful Plan Finder tool. By just typing in your zip code, you can see plans near you, complete with coverage details and star ratings so you can easily compare and contrast. If you find one you like, we can also help you get in touch with a licensed insurance agent, who can help you further explore your options or even enroll in a plan!

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