What are Medicare 5-Star Plans?
Last Updated : 05/02/20195 min read
Did you know that the government rates Medicare Advantage and Medicare Prescription Drug Plans? Based on patient feedback, doctor feedback, and other criteria, Medicare assigns one through five stars (unless a plan gets consistently poor ratings, which may result in Medicare terminating the plan). If a Medicare five-star health or prescription drug plan is available in your area, you might be able to sign up for the plan outside the usual enrollment periods if you meet certain eligibility requirements.
There are many private insurance companies contracted with Medicare that provide Medicare Advantage plans and stand-alone Medicare Part D Prescription Drug Plans across the country. Plans can vary in terms of coverage, cost, and even overall quality, although they do have certain coverage requirements by federal law. To help consumers choose plans, Medicare scores the plans in several different categories, such as quality of care and responsiveness to members; those with the highest scores become (or remain) Medicare five-star plans. Plans are evaluated every year and five-star plans must continue to score well to maintain their rating.
How are 5-star plans rated?
The Centers for Medicare and Medicaid Services (CMS) rates Medicare Advantage plans across several broad categories, including:
- Preventive health (health tests and screenings, vaccines)
- Chronic disease management
- Quality of care and responsiveness to members
- Member complaint handling, and how many members leave the plan
- Overall customer service
Stand-alone Medicare Part D Prescription Drug Plans and Medicare Advantage Prescription Drug Plans are evaluated in categories such as:
- Prescription drug safety
- Accurate pricing of prescription drugs
- Handling of member complaints
- Member plan ratings
- Overall customer service
Where can I find out which Medicare plans are 5-star plans?
You can use the Medicare plan finder tool on this page to look for Medicare plans and see their star ratings. Just enter your zip code in the box on this page and click Find Plans.
Medicare updates this information each October for the following plan year (ratings issued in October 2018, for example, apply to the January 2019 plan year).
Note that while Medicare five-star plans may merit a level of quality, you may also want to consider other factors when selecting your Medicare health plans and prescription drug coverage. For example:
- Does the plan include prescription drug coverage? If so, are the prescription medications that you take included in your plan formulary? (A formulary is a plan’s list of covered prescription drugs, sorted into price-based tiers. A plan’s formulary may change at any time. When required by law, you will receive notice from your plan of changes to the formulary.)
- Are your doctors and other preferred providers (hospitals, pharmacies) in the plan’s network?
- Are the plan’s out-of-pocket costs (premium, deductible, copayments or coinsurance) affordable for you?
When are 5-Star plans open to new enrollment?
One of the unique benefits of Medicare five-star plans is that they qualify for a longer special enrollment period than most other Medicare plans.
Here are the Medicare enrollment periods for both five-star plans and all Medicare plans in general:
- Initial Enrollment Period – When you first become eligible for Medicare, in most cases you have seven months to enroll, or you may be automatically enrolled. Read more about the Initial Enrollment Period here.
- General Enrollment Period – You may be able to enroll in Medicare Part A or Part B during this period, which runs from January 1 through March 31 each year with coverage beginning on July 1st. A late-enrollment penalty may apply.
- Special Enrollment Period (not for five-star plans) – There are various Special Enrollment Periods for Medicare Advantage and Medicare Prescription Drug Plans for various situations, mostly related to loss of coverage. For example, you may qualify for a Special Election Period if you move out of your plan’s service area, or the plan leaves your area.
- Annual Election Period – You may change your Medicare health plan or Prescription Drug Plan each year between October 15th and December 7th for coverage beginning January 1st.
- Special Enrollment Period – You can generally switch to a Medicare five-star plan once each calendar year, any time between December 8th (for coverage beginning January 1st of the following year) and November 30th (coverage begins on the first day of the month following enrollment).
As with any Medicare health plan or Prescription Drug Plan, you must live within the plan’s service area and continue paying your Medicare Part B premium. To enroll in a Medicare Advantage plan, you must be enrolled in Medicare Part A and Part B. To enroll in a stand-alone Medicare Prescription Drug Plan, you must be enrolled in either Part A or Part B (or both).
If you have questions about Medicare five-star plans, how star ratings work, or Medicare plans in general, I’m happy to help you understand your options. You can also request an email with personalized plan information, or schedule a return telephone call by clicking the corresponding link below. To view a list of plans in your area you may qualify for, click the “Compare Plans” button.