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 Medicare.gov’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.|
|2.5||14||Two of them are benchmark plans (Envision Rx Plus Silver and Aetna CVS/pharmacy).|