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

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 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.
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 Fletcher
Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.