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5 Star Special Enrollment Period 

Medicare beneficiaries have the ability to make a plan change outside of the Annual Enrollment Period using a Special Enrollment Period (SEP) which is based on special or specific circumstances. There is an often-overlooked SEP that provides a once-a-year opportunity, any time of the year, to switch from your current Medicare Advantage plan to another Medicare Advantage plan with a 5-star quality rating. This is called the 5 Star Special Enrollment Period. 

What is the 5 Star Special Enrollment Period 

In 2012, the Centers for Medicare and Medicaid Services (CMS) established a Special Enrollment Period (SEP) allowing Medicare beneficiaries to switch to a 5-star plan at any point during the year.  

CMS has several categories for quality and performance when it comes to rating plans and 5 stars is the highest rating.  The information that Medicare uses to rate plans comes from sources such as member surveys and healthcare provider data. Plans are rated based on different categories including how they engage members in using preventative care, managing chronic conditions, member satisfaction, and customer service.  

Each year CMS updates the plans ratings and those are usually posted each fall. As plans continue to make improvements, the industry is gaining more 5 Star rated plans each year. 

The 5-star SEP can be used at any time during the plan year beginning on December 8 and continuing through November 30. If a member were to enroll during this time, the new Medicare plan coverage begins the first day of the month after enrollment. 

Who can use the 5 Star Special Enrollment Period 

You are eligible to use this SEP if you are already in a Medicare Advantage plan (either MA only or MAPD with drug coverage) or if you have coverage from Original Medicare and meet the Medicare Advantage eligibility requirements. This includes being enrolled in both Medicare Parts A and B and living in the plan’s service area.  

The 5 Star SEP can only be used once between December 8 and November 30, so just like any other enrollment period, you should make sure the plan is the right fit before enrolling. If you choose to use the 5 Star SEP, you are locked into that plan until the next Annual Enrollment Period, unless you have a special circumstance that opens a different Special Enrollment Period.   

It is also important to note that these 5 Star rated plans are not available in all areas, so it is important to work with a local agent when considering a plan change. If you are considering a plan change and would like to find out if there is a 5 Star plan available in your area, VibrantUSA can help. Give us a call today at 866-733-5111.  

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