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Expand your Medicare coverage with a Medicare Advantage Plan. Some plans may offer additional coverage for prescription drugs, dental and vision.

5-Star Medicare Advantage Plans

All Medicare Advantage plans (Medicare Part C) and Medicare prescription drug plans (Medicare Part D) are assigned an annual star rating by the Centers for Medicare & Medicaid Services (CMS).1

A five-star rating system is used, with one star being given to the lowest-rated plans, and five stars being reserved for only the highest-rated plans. Star Ratings are calculated each year and may change from one year to the next.

To enroll in a 5-star Medicare Advantage plan, you can call TTY Users: 711 to speak with a licensed insurance agent about 5-star plans that may be available where you live.

Let’s take a look at five-star Medicare Advantage plans, including what makes them so valuable and the steps you can take to enroll in one.

Woman smiles as doctor gives prescription

The Medicare star rating system

The star rating system for Medicare Advantage plans is as follows:

Star Ratings

★★★★★

Excellent

★★★★

Above Average

★★★

Average

★★

Below Average

Poor

The rating system uses five key metrics in its assessment of a Medicare Advantage plan:

  1. Screening tests and vaccines
    This review criteria evaluates the level of access plan members have to preventive services, including annual physical exams and screenings.

  2. Management of chronic conditions
    This criteria includes the coordination of care under a given Medicare Advantage plan and evaluates how often members received treatment for long-term health conditions.

  3. Member experience with the plan
    This criteria evaluates plan members’ overall satisfaction with the given plan.  

  4. Member complaints and changes in plan performance
    How frequently did plan members submit complaints about the plan, have problems receiving covered services or opt out of the plan? This rating criteria also reflects whether the plan’s performance improved from the previous year.

  5. Customer service
    The quality of call center service and the efficiency of the appeals and enrollment process are closely evaluated as part of the overall plan customer experience.

In addition to an overall rating, each Medicare Advantage plan is rated in each of the five individual categories. Medicare Star Ratings are released in October of each year for the upcoming calendar year.

If a plan receives a rating of fewer than three stars for three consecutive years, it becomes flagged by the CMS as a low-performing plan. If the plan continues to underperform, Medicare may remove the plan entirely from the marketplace.  

How to find a five-star Medicare Advantage plan

Because the availability of Medicare Advantage plans varies from one location to the next, you may want to call TTY Users: 711 to speak with a licensed insurance agent.

An agent can go over the plan options available in your area and identify which ones have received a five-star rating.

An agent can also discuss the costs, terms, coverage and other details about available plans, which can be helpful for you to know prior to enrolling. And if you choose to enroll, the agent can walk you through the steps and help you complete the process.

When to enroll in a five-star Medicare Advantage plan

There are five times in which you may enroll in a five-star Medicare Advantage plan.

Initial Enrollment Period

1. When you first become eligible for Medicare Advantage

You can sign up for a five-star plan — or a plan of any rating for that matter — when you first become eligible for Medicare Advantage. Your eligibility begins once you are enrolled in both Medicare Part A and Part B (and you do not have End-Stage Renal Disease).

You are given a 7-month Medicare Initial Enrollment Period. This period begins three months before you turn 65 years old, includes the month of your birthday and continues for three months thereafter.

You are only eligible to enroll in plans that are offered in your area.

*If you are under 65 years old but qualify for Medicare because of a disability, you will be eligible to enroll in a Medicare Advantage plan following your 21st month of collecting disability benefits and will have until the end of your 28th month of collecting benefits to complete your enrollment.

Open Enrollment Period

2. The fall Medicare Open Enrollment Period

If you are already enrolled in Part A and/or Part B, you may sign up for a Medicare Advantage plan during the fall Medicare Open Enrollment Period, which lasts from October 15 to December 7 each year.

If you are already enrolled in a Medicare Advantage plan, you may use this time to switch to a different Medicare Advantage plan.

3. Between April 1 and June 30

If you already had Part A of Medicare but waited to sign up for Part B during the Medicare General Enrollment Period (January 1 to March 31 each year), you will be able to sign up for a Medicare Advantage plan between April 1 and June 30.

4. The Medicare Five-Star Special Enrollment Period

If you are currently enrolled in a plan that is rated as fewer than five stars, you may utilize the Medicare Five-Star Special Election Period to disenroll from your current plan and enroll in a five-star Medicare Advantage plan.

This period lasts from December 8 to November 30 of the following year, which means you have almost an entire year to make the appropriate change. You can only enroll in five-star plans during this time.

5. A Special Election Period

Being enrolled in a Medicare Advantage plan with fewer than five stars isn’t the only way to qualify for a Special Enrollment Period.

Special Enrollment Periods may be granted to individuals for a variety of circumstances, such as living outside of the U.S. at the time of your initial Medicare eligibility, or residing in a long-term care facility.  

Contact a licensed insurance agent today to learn more about the five-star Medicare Advantage options near you. Call TTY Users: 711 24 hours a day, 7 days a week to get started.

 

Related articles:

 

1 Every year, Medicare evaluates plans based on a 5-star rating system.

Copyright 2018 TZ Insurance Solutions LLC. All rights reserved.

*$0 premium plans may not be available in all areas.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. 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 www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.