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.
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.