Yes. If you are enrolled in a Medicare Part D or Medicare Advantage plan identified by the Centers
for Medicare and Medicaid Services (CMS) as consistently low-performing, CMS will send you a letter informing you that your Medicare Part D drug plan or Medicare Advantage health plan has
failed to achieve at least a 3-star quality
rating for three straight years.
In the notice, CMS will offer you a Special Enrollment Period (SEP) so that you can change to another Medicare Part D or Medicare Advantage plan outside of the annual Open Enrollment Period (that begins October 15th and ends December 7th).
Please note, there is usually a relatively small number of people enrolled in a consistently low-performing Medicare plan who can take advantage of this Special Enrollment Period (SEP). In addition, you may also notice that some people refer to this Special Enrollment Period as the SEP for "Consistent Poor Performers".
Question: What can we expect from the CMS mailing on low-performing Medicare plans?
If you are in a consistently low-performing Medicare plan, CMS will send you a written notice in late-October entitled: "Important Information About Your Medicare Plan Options" and the CMS notice may include text such as:
No. This is a once-a-year opportunity. The low-performing SEP can only be used once during the plan year and is designed for you to enroll in a Medicare plan with a 3-star or higher quality star rating.
In the notice, CMS will offer you a Special Enrollment Period (SEP) so that you can change to another Medicare Part D or Medicare Advantage plan outside of the annual Open Enrollment Period (that begins October 15th and ends December 7th).
Please note, there is usually a relatively small number of people enrolled in a consistently low-performing Medicare plan who can take advantage of this Special Enrollment Period (SEP). In addition, you may also notice that some people refer to this Special Enrollment Period as the SEP for "Consistent Poor Performers".
Question: What can we expect from the CMS mailing on low-performing Medicare plans?
If you are in a consistently low-performing Medicare plan, CMS will send you a written notice in late-October entitled: "Important Information About Your Medicare Plan Options" and the CMS notice may include text such as:
"You are currently enrolled in <ORGANIZATION’S NAME>’S <PLAN NAME>. <ORGANIZATION NAME> has been rated “poor” or “below average” for at least the last three years. We encourage you to compare this plan to other options in your area and decide if it is still the right choice for you."Question: Can I use this Special Enrollment Period more than once?
No. This is a once-a-year opportunity. The low-performing SEP can only be used once during the plan year and is designed for you to enroll in a Medicare plan with a 3-star or higher quality star rating.
Question: How do get access to this Special Enrollment Period so I can change plans?
Only a Medicare representative can provide you with this Special Enrollment Period. If you call Medicare (1-800-633-4227) to ask about the consistently low-performing SEP, you can refer to your notice letter as "CMS Product No. 11627" or "11627-S" (Spanish).
Question: How is Medicare Drug plan quality evaluated?
Here is an example of the type of criteria used to evaluate Medicare plans and used to develop Medicare plan quality or "star" ratings.
Drug Plan Customer Service
• Call Center – Foreign Language Interpreter and TTY Availability.
Member Complaints and Changes in the Drug Plan’s Performance
• Complaints about the Drug Plan.
• Members Choosing to Leave the Plan.
• Drug Plan Quality Improvement.
Member Experience with Drug Plan
• Rating of Drug Plan.
Drug Safety and Accuracy of Drug Pricing
• MPF (Medicare Plan Finder) Price Accuracy.
• Medication Adherence for Diabetes Medications.
• Medication Adherence for Hypertension (RAS Antagonists).
• Medication Adherence for Cholesterol (Statins).
• MTM Program Completion Rate for CMR.
• Statin Use in Persons with Diabetes (SUPD).
To view all of the criteria for Medicare Advantage plans and Medicare Part D plans...
The Medicare Part C (Medicare Advantage plan) and Medicare Part D prescription drug plan Star Rating Measures (and the sources of the ratings) can be reviewed on this site PartD-StarRatingsMedicareQualityRating.php
Reference:
CMS provides the following:
"CMS Notice to Individuals Enrolled in Plans with Fewer Than Three Stars for Three or More Consecutive Years
CMS will further the goals of facilitating beneficiary enrollment into higher quality plans by issuing notices to individuals enrolled in plans with fewer than three stars for three consecutive years. The notices inform enrollees of an opportunity to contact CMS to request a special enrollment period (SEP) to move into a higher quality plan. Plans are not able to effectuate enrollments for this one-time SEP; all requests must come into CMS via 1-800-MEDICARE by the beneficiary and will be handled on a case-by-case basis. Spanish and English notices are mailed to current members in October."
(https://www.cms.gov/Medicare/ Eligibility-and-Enrollment/ MedicareMangCareEligEnrol/ - as of 07/11/2017)
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