Medicare’s star rating system makes it easy for clients to compare plans and make the best decisions for their needs. Thanks to a Special Enrollment Period (SEP), your client can switch to a higher-quality plan outside of the Annual Enrollment Period (AEP).
Listen to this article:
Obviously, you want to get your client the best Medicare coverage possible. Understanding the star ratings system and the 5-star plan Special Enrollment Period will help you do just that.
What Is A 5-Star Medicare Advantage Plan?
Every year, the Centers for Medicare & Medicaid Services use information from member satisfaction surveys, plans, and health care providers to rate Medicare Advantage (MA) and Part D plans on a 1- to 5-star scale. Using these ratings, you can help clients compare plans and find high-quality coverage.
How Are Medicare Advantage Plans Rated?
MA plans with prescription drug coverage are rated on up to 38 quality and performance measures while MA-only plans are rated on up to 28 measures. Each are measured on the following domains:
Star Rating Domains
| MAPD | MA-Only |
|---|---|
| Staying Healthy: Screening Tests, and Vaccines | Staying Healthy: Screening Tests, and Vaccines |
| Managing Chronic (Long-Term) Conditions | Managing Chronic (Long-Term) Conditions |
| Member Experience with Health Plan | Member Experience with Health Plan |
| Member Complaints and Changes in Health Plan’s Performance | Member Complaints and Changes in Health Plan’s Performance |
| Health Plan Customer Service | Health Plan Customer Service |
| Drug Safety and Accuracy of Drug Pricing |
A plan receives a score in each category, as well as a final star rating. One star represents poor performance, while five stars is given to excellent plans. Plans that receive lower than a 3-star rating for three years in a row are flagged by CMS and labeled as a low-performing plan. Continuing to underperform may lead to the plan’s removal from the Medicare marketplace.
CMS releases new star ratings each fall. Medicare Advantage plans that are new to the market won’t receive a star rating right away since there isn’t enough feedback data on the plan’s performance.
5-Star Medicare Plans for 2022
An easy way for you and your clients to find 5-star plans in your area is to use PlanEnroll. You can simply enter their zip code to compare top-rated plans in the area. Additionally, when you register with Ritter and use our Medicare Quote Engine within the Ritter Platform, you can filter all available plans in a zip code by star rating.
We also suggest contacting your Ritter sales rep for the quickest assistance when discovering these sales opportunities! Making sure you have all the tools you need to provide quality coverage is our priority.
The 5-Star Plan Special Enrollment Period
If there’s a 5-star MA, Medicare drug, or Medicare cost plan in your client’s service area, they can switch from their current plan to that one using the 5-Star Special Enrollment Period (SEP). They can only use this SEP once from December 8 to November 30.
Clients can only use this Special Enrollment Period once from December 8 to November 30.
Enrollments made from December 8 through December 31 are effective January 1. Any enrollments after are effective the month after you submit the request.
Should Clients Make the Switch?
Even though it may seem like a no-brainer to switch from a lower-rated plan to one with the distinguished five stars, that might not always be the right option for your client.
For example, if your client decides they want to move from an MAPD plan to a 5-star stand-alone Medicare prescription drug plan, they’ll be disenrolled from their MA plan and return to Original Medicare for coverage of their health services.
If your client decides they want to move from a MAPD plan to a 5-star stand-alone Medicare prescription drug plan, they’ll be disenrolled from their MA plan
Your clients might also run into trouble and lose their prescription drug coverage if they move from an MA plan that has drug coverage to a 5-star plan that doesn’t. In that case, they’ll have to wait until the Annual Enrollment Period or for another SEP to get drug coverage. They may even have to pay a Part D late enrollment penalty.
With that in mind, we expect a more common use of the 5-star SEP would be a client changing their primary health coverage by moving from a lower-performing MAPD plan to a 5-star MAPD plan. If the provider network and cost are still good fits for your client, it’s a logical upgrade for them.
5-Star Plan Marketing Guidelines
Please note that 5-star plans should only be marketed in areas where they are available. Generally speaking, materials referencing these types of plans must include these disclaimers:
- “Every year, Medicare evaluates plans based on a 5-star rating system.”
- “Partner/Agency is a licensed and certified representative of Medicare Advantage organizations. Each of the organizations they represent has a Medicare contract. Enrollment in any plan depends on contract renewal. Partner/Agency does not offer every plan available. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day, 7 days a week, or consult Medicare.gov.”
This probably isn’t the first time you’re hearing about 5-star plans, but it may be the first time you started thinking seriously about marketing these options. With their increasing popularity and evergreen opportunity to switch into one, what better time to offer your clients the best of the best?
Ritter is here to help with all your 5-star plan needs! Register with our site for free and get access to exclusive resources like our Medicare Quote Engine.
Not affiliated with or endorsed by Medicare or any government agency.
Share Post