Beneficiaries Gain a New Right to Switch to a 5-Star Health Plan Starting 12/8/11

As a way to reward Medicare Advantage (MA) and Part D plans that receive high performance ratings by the Centers for Medicare and Medicaid Services (CMS), and to guide beneficiaries toward such plans, there will be a new Special Election Period (SEP) allowing Medicare beneficiaries to enroll in MA and Part D plans that receive an overall 5-star rating by CMS’s Plan Performance Rating system. This right will start on December 8, 2011 and ends November 30, 2012.  The 5-Star SEP can only be exercised once per year.  Plan ratings for 2012 are available now on’s Plan Finder Tool.

Very few plans in 2011 achieved 5-star status. In California, no stand-alone Part D plans achieved this status. Kaiser’s Senior Advantage HMO plan in several counties is the only MA plan that received a 5-star rating.

Note that using the 5-Star SEP does not guarantee Part D coverage. If a beneficiary in either an MA-PD plan or a PDP chooses to enroll in an MA-only plan with a 5-star overall rating, that beneficiary would lose Part D coverage and must wait for a subsequent enrollment period to obtain Part D coverage (such as the Annual Election Period from Oct 15 – Dec 7 each year). Late enrollment penalties might also apply.

Here’s a summary of the star ratings for the PDPs in California:

Star rating How many PDPs? Comments
4 5 Dominated by Medco and Blue Shield.  Two of the Blue Shield PDPs are new – please note that the ratings are based on the sponsor and not the individual plan.
3.5 2 Both WellCare.
3 12
2.5 14 Two of them are benchmark plans (Envision Rx Plus Silver and Aetna CVS/pharmacy).

Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.