CMS rated five star Medicare Advantage Plans qualify you for a Special Enrollment Period
Do you feel as though your flexibility to enroll in a Medicare Advantage Plan is limited by the narrow window of the Annual Enrollment Period? If so, you may now have another option to enroll in or make changes to your existing Medicare Advantage Plan choice.
CMS has established a Special Enrollment Period for Medicare beneficiaries to enroll in a 5 star Medicare Advantage Plan at any point during the year.
Who is eligible?
Eligibility guidelines are fairly liberal but the caveat is that you must have a CMS rated five star Medicare Advantage Plan available in your service area. Many Counties have limited options for beneficiaries to enroll in a Medicare Advantage Plan let alone a five star rated Advantage Plan. You are eligible if you have a five star plan available and you:
- Are enrolled in a Medicare Advantage Plan with a star rating of 4.5 or less.
- You are enrolled in original Medicare and meet the eligibility requirements for Medicare Advantage.
Part D status is not a factor in determining this Special Enrollment Period.
Remember, to be eligible for Medicare Advantage you must:
- Have Medicare Parts A and B.
- Live in the service area of the plan.
- Do not have end-stage renal disease (with few exceptions).
There are several resources online to compare Medicare Advantage Plans. many people have found eHealthInsurance to be helpful and easy to navigate. You can also call 888 310-0376 to speak with a licensed agent knowledgeable about plans in your area.
Finding five star rated Medicare Advantage Plans
Plan ratings are published on the Medicare website in the fall each year prior to the annual open enrollment period.
It’s important to note that just because a plan has been awarded a 5 star rating, it may not be, in all cases, your best option. For example if a Medicare HMO plan is rated 5 stars and your providers are not in network you may want to decide whether or not changing providers is in your best interest.
The downside of this Special Enrollment Period is that it will only be available to those people who have a 5 star rated plan or plans in their service area. Like most regulatory changes this will likely cause some confusion and feelings of disappointment if 5 star plans are not available.
Here are the Mistakes to Avoid When Choosing a Medicare Advantage Plan
Why create a special Enrollment Period for CMS 5 star rated plans?
CMS is attempting to push plan sponsors to design more benefit rich plans that provide a higher level of quality to plan members. This change in combination with quality bonus payments to plan sponsors is designed to ensure that beneficiaries have plans that offer a true value.
The question is, will it work? On the surface it seems to make sense, but how objective is the plan rating system? And will it lead to a field of 5 star rated plans or merely less choice because non-5 star rated plan will lose members mid-year and potentially become non-viable the following year?
Only time will answer these questions, but in the meantime you may have more flexibility to move from plan to plan or enroll in a plan at any time during the year.
I find it very upsetting that Medicare assist patients that are 65+ in offering a secondary insurance. However, if you are disabled there are no plans out there for you and no Medicare assistance either. If anyone needs the assistance it is those of us that are on disability. We are forced to either be on straight Medicare have loads of bills over what Medicare does not cover & or filed bankruptcy on medical or take out an Medicare advantage plan if there is one in our area. Then we are still subject to large copays, which are required to be paid prior to services being rendered.
Jean, The secondary insurance that you are referring to is a Medigap policy also known as a Medicare supplement. Medicare does not assist those over 65 to purchase a Medigap policy but rather requires an Open Enrollment period and Guaranteed Issue periods for changes in a beneficiary’s circumstances much like special Enrollment Periods for Medicare Advantage Plans. Many people over 65 cannot afford this type of policy and have a similar situation to which you refer.
Each State has insurance regulations regarding whether insurance companies that offer Medigap are required to make policies available to those Medicare beneficiaries on disability and under 65. Many States require that Medigap is offered and some do not. Those insurance companies that do offer under 65 policies generally charge a higher premium for that group.
So if you are upset it should be about your State’s insurance regulations not Medicare.
Also Jean, every state and most territories have a State Health Insurance Assistance Program (SHIP). These programs are funded by Medicare to help seniors and the disabled to find the best benefits and to enroll in cost-saving programs. In Florida, the program is called SHINE and can be reached at 1-800-963-5337. To find a SHIP somewhere else, visit https://shiptalk.org/About/SHIProfileSearchForm.aspx?mf=Display.
Andrea, Thanks for sharing the link to SHIP. This is a great resource.
Hi David – I don’t see any mention of the special enrollment period for the CMS rated 5 star plans in the Medicare & You 2011 manual.
Elizabeth, The SEP to enroll in a 5 Stare rated plan begins in 2012. The 2011 Medicare & You Handbook is for 2011 plans and guidelines.
I live in San Luis Obispo County (Ca.) zip 93465. At one time the AARP Secure Horizons Medical Complete HMO was ffered her, but now this zip code only offers one Medicare Advantage plan, Arcadian. What department in Medicare has the power to limit certain zip codes to be open for a given plan, or closed out so you can no longer enroll? Insurance companies say it’s forced upon them by Medicare. I can get no straight answers on this. Can you help? Thanks, Billy
Billy, The insurance companies that offer Medicare Advantage plans have the ball in their court. No department in Medicare has the authority to require insurance companies to market in any service area. The insurance companies are able to make this decision once they are approved and contacted with Medicare.
I cannot find the drug formulary telling me what tier Plavis 75 mg is in ???
Irene, Medicare Part D drug formularies vary from plan to plan. also, 2012 Part d formularies will not be available for review until October 1. If you currently have a plan contact customer service and request a printed formulary. After October 1 you can visit medicare.gov and search for plans. Be sure to include your medications to see all plans in your area that include Plavix 75MG.
David, my husband reached 65 years old and we are looking for the best plan that fits our economy. I found AARP complete advantge plan, but some people is telleing to me to not give up the Medicare Original.
Please advice. We live in Illinois.
Carmen, There is a lot of confusion surrounding Medicare Advantage. When you enroll in an Advantage plan like AARP MedicareComplete you are not giving up Medicare you are merely receiving your benefits from the Advantage plan. I offer a Mini-course on this site that goes into detail how a Medicare Advantage plan works. Enter your email in the web form on the top right of the page and after a couple days things will make more sense.
IS SCAN 5 STAR RATED? HOW WOULD I ACCESS THAT INOFRMATION?
Anthony, Normally you can find this information at http://www.medicare.gov but it is not yet available. I would expect it soon.
.. WHEN AND HOW DO I SIGN UP FOR MEDICARE? IS THERE A FORM I NEED TO FILL OUT LIKE(40B) CAN YOU E-MAIL ME A COPY OF THAT FORM… THANK YOU… PARRISH NICHOLS
Parrish, Generally you don’t need to sign up as long as you have worked and paid Medicare tax. Medicare will send you information in the mail. If you want to be certain that they don’t drop the ball visit http://www.medicare.gov to sign up.
Normally you get on Medicare at age 65 unless you are trying to get on Medicare at an earlier age due to a disability. Normally, once you turn 65, you will receive a Medicare card in the mail and it will include part A & part B. If you do not want part B at that time you can send the card back and indicate you don’t want part B. Part B does cost a premium while part A is normally no premium. Normally it is better to keep Part B because in order to get a Medicare Advantage Plan or a Medicare Supplement is required. In a case where a person can quilify for MediCAID, then your part B premium will be paid for them. About the only time a person might delay part B is if they are still working and covered through a group plan through an employer beyond age 65.
How do I find out which plans are considered 5 star? I have accidently gotten signed up for two insurances. What can I do?
Wanda, Both Medicare advantage and Part D can be rated as 5 star but very few are. Visit medicare.gov and click Compare drug and Health Plans, follow the onscreen prompts to locate plans in your area. Each plan will list it’s star rating. It sounds like you may be enrolled in both a Medigap policy and a Medicare Advantage plan. If that’s the case your only option will be to cancel the Medigap policy. I say this because it is not possible to be enrolled in 2 Advantage plans as a new application must be processed through CMS and the new application automatically cancels the previous application. Conversely, if you have purchased 2 Medigap policies from different carriers, cancel the one you don’t want.
I wentt to the gov site but had no luck finding a 5 star rated advantage company. Where can I look this up and how do I do it. I currently have bravo classic.
sorry forgot to include that I live in garland tx
Laura, I checked medicare.gov for 5 Star Part D plans in Garland TX and there are none. This means that the Special Enrollment Period for 5 Star plans is not available to you. Unless you are entitled to another Special Enrollment Period you will have to keep the Bravo Classic Part D for the calendar year. I’m sorry I don’t have better news.
I was just beginning to type my comment, the phone rang
and already someone is trying to sell me on another plan,
wow, thats fast.
My comments are that after extensive review I feel more than satisfied with my BCBS plan that I’ve had for 3 yrs.
thank you, Ken Adams
Thanks for the update and all that you do to keep us Seniors
My friend is going through a divorce. She is 67, he is 61 and has insurance coverage for both of them through his union. When the divorce is final, probably in Sept. or Oct., will she be able to sign on to a Medicare Advantage plan at that time of the year, or will she have to pay for COBRA, or something like that, until Jan. 1 of next year? She apparently has medicare as the secondary insurer after the union insurance.
Keith, Should should receive some notification from her soon to be spouses former employer indicating that she is no longer covered on the group policy and that should qualify her for a Special Enrollment Period to join a Medicare Advantage plan. She must have both Parts A and B to do so. If she has not enrolled in Medicare Part B she should do so prior to losing coverage.
I know this particular forum is about the 5 star plan, but is this Special Enrollment Period for any Medicare Advantage plan? Incidentally, she will be moving to a different state, so can she apply for a Medicare Advantage plan in another state, even though it would be a couple months before she will be a resident? Thanks again for your replys!
If it is this complicated and confusing there is probably a lot fraud going on as well as waste. Seems to me this needs to be simplified
Dennis, I know what you mean. This special enrollment period was designed to get plan sponsors to offer a more quality product but there are very few 5 star plans available. Maybe we would be better off with a Medicare voucher system.
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