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Switching to a 5 Star Medicare Advantage Plan

Last updated June 18th, 2020

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You can trust that you’re getting high-quality health insurance when you enroll in a five star Medicare Advantage plan. Because a five-star rating is the top rating for Medicare Advantage (also called Medicare Part C), it’s a good way to judge whether that plan is the real deal.

By law, you have extra opportunities to join a five star Medicare Advantage plan. If you’re thinking about leaving your current plan to enroll in another that’s rated five stars, we can help you make and act on an informed decision.

What Does a Five Star Medicare Advantage Plan Mean?

Medicare Advantage plans are rated from 1 to 5 stars, with five stars being an “excellent” rating. This means a five-star plan has the highest overall score for how well it offers members access to healthcare and a positive customer service experience.

Here’s a look at what each star rating means to help you better understand a five-star rating.

  • ★★★★★ — excellent
  • ★★★★ — above average
  • ★★★ — average
  • ★★ — below average
  • ★ — poor

If a Medicare Advantage plan also includes Part D prescription drug coverage, which most do, then five stars also indicate the plan does an excellent job at offering members access to safe drugs that are priced accurately. This should give you a boost of confidence when choosing a five star Medicare Advantage plan that includes coverage for your medications.

How Are Medicare Advantage Plans Rated Five Stars?

Fortunately, Medicare Advantage plans don’t get an excellent rating by just wishing upon a star.

The Centers for Medicare & Medicaid Services (CMS) has many categories for quality and performance that a plan must meet before it can get a rating of five stars. Medicare star ratings help protect you as a customer because they let you understand how a plan compares to its peers.

A Medicare Part C plan earns five stars if it has the best overall score for health services and drug coverage (if the plan offers this benefit) in these areas:

Medicare Advantage Health Services Are Rated in These 5 AreasMedicare Advantage Drug Benefits Are Rated in These 4 Areas
1. Staying healthy: screening tests and vaccines1. Drug coverage customer service
2. Managing chronic (long-term) conditions2. Member complaints and changes in the drug plan’s performance
3. Member experience with the health plan3. Member experience with the drug plan
4. Member complaints and changes in the health plan’s performance4. Drug safety and accuracy of drug pricing
5. Health plan customer service

The information Medicare uses to rate a plan five stars comes from these sources:

  • Member surveys
  • Information plans and healthcare providers submit to Medicare
  • Medicare’s regular monitoring
  • Billing and other information about drug coverage that plans submit to Medicare

Are There Any Five Star Medicare Advantage Plans?

Yes! Of the 22 million people who have Part C coverage in 2019, nine percent are enrolled in a plan that’s rated five stars.1

However, it may be easier to find plans with a 4 or 4.5 star rating because more people are enrolled in Medicare Part C plans that have these ratings.

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List of Five Star Medicare Advantage Plans

Below is a list of 2020 five star Medicare Advantage plans that include Medicare Part D drug coverage. Keep in mind that these plans may not have the same rating come 2021, because ratings can change from year to year.

  1. Kelsey-Seybold Administrators in Texas
  2. Kaiser Foundation Health Plan in California
  3. Kaiser Foundation Health Plan of Colorado 
  4. CarePlus Health Plans in Florida
  5. Florida Blue Medicare
  6. Kaiser Foundation Health Plan of Georgia
  7. Kaiser Foundation Health Plan in Hawaii 
  8. Martin’s Point Generations Advantage in Maine and New Hampshire
  9. Care Improvement Plus South Central Insurance Co. in New York
  10. Kaiser Foundation Health Plan of The Mid-Atlantic States in Maryland and Virginia
  11. Kaiser Foundation Health Plan of the Mid-Atlantic States in Maryland, Virginia and Washington, D.C. (different contract)
  12. Tufts Associated Health Maintenance Organization in Massachusetts 
  13. Group Health Plan in Minnesota, North Dakota, South Dakota, and Wisconsin 
  14. Aetna Health in Maine
  15. UnitedHealthcare Benefits of Texas
  16. Kaiser Foundation Health Plan of Washington 
  17. Quartz Health Plan Corp. in Iowa, Illinois and Wisconsin
  18. HealthSpring of Florida
  19. Healthsun Health Plans in Florida
  20. Quartz Health Plan Minnesota Corp.2

How and When Can You Join a Five Star Medicare Advantage Plan?

You can make this switch during the Five Star Special Enrollment Period (SEP), which takes place from December 8 to November 30. It’s in addition to the main Medicare Advantage Open Enrollment Period, when you can switch to all types of Medicare Advantage plans.

Use a site like HealthCare.com to search for 5 star plans with the help of a licensed Medicare agent. They can help you switch coverage using the Five Star SEP. If you’re unable to sign up online, contact the plan directly for enrollment paperwork.

If you already know a five-star plan is available in your area, make sure to check if it comes with Part D prescription drug benefits. An excellent, five-star rating doesn’t mean drug coverage is automatically included.

Here are some things to keep in mind:

  • If you’re leaving a Medicare Advantage plan that includes prescription drug coverage and joining a five star MA plan that doesn’t offer this benefit, you may end up losing your drug coverage.
  • If you lose your drug coverage, you may have to wait until the next time you’re eligible to enroll in drug benefits but you could face paying a Part D late enrollment penalty.

When Are Five Star Advantage Plans Updated and Posted?

Each year, CMS does a checkup on Medicare plans that use the star rating system. The results are updated and posted every fall, usually in October.

Similar to an annual checkup you get from your doctor, measuring how well Medicare Advantage plans are performing every year is a good thing for you! This ensures that plans continue to provide you with access to quality healthcare and top-notch customer service.

After all, you’re trusting Medicare to help take care of your health. A five star Medicare Advantage plan is a sure way to know you’re well covered!

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Article Sources
  1. Jacobson, Gretchen, Meredith Freed, Anthony Damico, and Tricia Neuman. “A Dozen Facts About Medicare Advantage in 2019.” kff.org, June 6, 2019 (accessed March 2020).

     

  2. Centers for Medicare and Medicaid Services. “Fact Sheet – 2020 Part C and D Star Ratings.” cms.gov (accessed March 2020).