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Medicare 5 Star Rated Advantage Plans

You can enroll in a Medicare 5 Star Advantage plan anytime – but are they available?Five Gold Stars

One of the major complaints for people enrolled in a Medicare Advantage plan is that they are locked-in for the entire year. If you are unhappy with your plan there has been little opportunity to make a change outside of the annual Open Enrollment Period.

To remedy this situation and reward companies who offer plans that preform well CMS announced last year that beginning in 2012 a New Special Enrollment Period would be available.

The general idea is if you are enrolled in a Medicare Advantage plan that is rated at 4.5 Stars or less or are enrolled in original Medicare and meet the requirements for Medicare Advantage enrollment, you can switch or enroll in a Medicare 5 Star rated plan anytime during the year. You are able to do so one time. But, do you readily have 5 Star rated plans available in your County? And if so, does a 5 Star rating automatically make it a better choice for you?

Finding Medicare 5 Star rated plans if you would like to switch

Barely a day goes by that I don’t receive a comment or an email asking me how to get out of a Medicare Advantage plan. Often times the comment includes a rant about how the company didn’t live up to expectations. (More about this later).

Here are the steps to determine if you have any Medicare 5 Star Advantage plans in your County:

  1. Visit medicare.gov and click, Compare Drug and Health Plans
  2. Enter your zip code and click, Find Plans
  3. Step 1 of 4: Answer the two questions
  4. Step 2 of 4: click, I Don’t Want to Add My Drugs Now… Skip Drug Entry
  5. Step 3 of 4: click, I Don’t Want to Add Pharmacies Now…Skip Pharmacy Selection
  6. Step 4 of 4: Choose plan type and click, Continue to Plan Results
  7. Expand results to show maximum number of plans. Star rating is displayed on the right.

I recommend not adding your drugs and pharmacies initially, as you may waste a lot of time only to learn that no Five Star Medicare Advantage plans are available. It’s also important to expand the number of plan results, as it defaults to ten.

Now we come back to the question of whether or not you have any Five Star Medicare Advantage plans available. CMS routinely beats their own drum about how the Affordable Care act has had a positive impact on Medicare and Medicare beneficiaries, but little is available about the number of 5 Star plans.

A press release from CMS dated February 1, 2012 titled, “Medicare Advantage Premiums Down 7 Percent on Average, Enrollment up 10 Percent“, sheds some light on this lack of information about the number of 5 Star plans.

Some specific data reported includes:

  • The average premium for 2012 is $31.54 down from $33.97 in 2011
  • 2012 Advantage plan enrollment has risen to 12.8 million from 11.7 million in 2011
  • There are an average of 26 plans per County nationwide
  • 99.7% of beneficiaries have a plan available

The information about the number of 5 Star rated plans is less specific… “Not only are average premiums lower, but plans are better, with more beneficiaries enrolled in 4 and 5 star plans,” said CMS Acting Administrator Marilyn Tavenner.

Truth or spin?

The CMS Newsroom press releases read like a for-profit company informing you that their products are the best. But how much is spin?

For instance:

  • If your premiums went down, did your benefits remain the same or does it cost more to use your plan in 2012?
  • With 10,000 Baby Boomers turning 65 every day beginning in 2011 would you expect higher enrollment numbers?
  • Are enrollment numbers up because beneficiaries have less disposable income to pay the higher premium of a Medigap policy?
  • And why no specific data on the number of 5 Star rated plans? hmmmm….

I’m guessing that there are not very many 5 Star rated plans to choose from…. what do you think?


Why you need to get it right the first time

Back to the emails and comments about being unhappy with the Advantage plan chosen. The stakes are too high to enroll in a plan because the advertising is warm and fuzzy or because it’s the only plan carried by your favorite insurance agent. Just because you attended a Medicare seminar and liked the presentation doesn’t mean the plan presented was your best option. You have to do your homework. Here are the biggest complaints raised on this site and in emails about Medicare Advantage plans:

  • Network restrictions
  • Quality of doctors in the network
  • Drugs not covered by plan
  • No providers for ancillary benefits such as dental

All of these problems can be addressed prior to submitting an application. Here are some Medicare Advantage enrollment tips. The time to learn about these possible short falls is prior to signing on the dotted line. Even though there exists a Special Enrollment Period for Medicare 5 Star rated Advantage plans don’t count on it as a guarantee that one will be available in your County.

5 comments

  1. The best I can do in my county is 3.5 stars, and my personal rating would be .25 stars. My best advice is to ignore the current Democrat administration. As usual, they are full of hype. As for the wannabe Republicans, per Mr. Ryan they are going to issue us vouchers for health care. Sounds like a 5-star ticket to a death camp?

  2. So far my Advantage Plan has worked pretty well going on three years,but I really read it very well,I mean over and over before I chose. My question is how long before the doughnut hole is closed? Thank you for all your information Mr. Forbes.And yes, vouchers for us to me sounds really scarry.

  3. Patti, Your smart to pay close attention to your plan’s Summary of Benefits. Continue to do so as a plan can change annually. The donut hole is to be completely eliminated by 2020.

  4. I was told by my Advantage plan that they had made changes as of April 2012 and refused to pay for my effedural which I had no problem previously. (hHealth America)Advantra. I am now in excruting pain from a botched back surgery. I have had several before this I do not understand this.

  5. Franklin,
    D plans can change formularies mid-year. This seems to be a cruel trick especially since members are locked-in until December 31st. Speak with your doctor to file an appeal with your plan. there is no guarantee but it has worked for others.

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