Beneficiaries in Low-Rated Plans Given Opportunity to Change Coverage

The 2013 quality ratings for Medicare Advantage and Part D prescription drug plans were posted on in early October. The Centers for Medicare and Medicaid Services (CMS) rates plans on a variety of quality care measures with 1 star being the lowest rating and 5 stars the highest. As Medicare’s fall Open Enrollment (also called Annual Election Period) is now through December 7, this is a good tool for beneficiaries to use when choosing whether to change their health coverage for the new year. This rating system is also one way CMS is encouraging and rewarding plans that provide quality care.

In addition, beneficiaries who are in a low-rated plan, one that has received less than 3 stars for 3 consecutive years, now have the right to switch to another, higher rated plan. CMS has sent out over 500,000 notices to such beneficiaries in October, encouraging them to consider switching plans. Beneficiaries in low-rated plans who do not make a change within the Annual Election Period (Oct 15- Dec 7), and decide later that they would like to, can call 1-800-MEDICARE to do so.

Also, if beneficiaries live in an area with a 5 star rated plan, they have the right to switch to that 5 star plan anytime between December 8 and November 30. Their coverage will begin on the first of the following month. Note that not all areas have 5 star rated plans. In fact, there are very few plans with such high ratings. In 2013, only 9 out of 555 Medicare Advantage contracts are with 5 star plans, and only 4 out of 74 Part D contract are with 5 star plans. California does have some MA 5 star plans but no Part D 5 star plans for 2013.

For more info on other periods when beneficiaries can change coverage, see our section Special Election Periods (SEPs) for Parts C & D.

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.