A little background: What is the 5-Star Special Enrollment Period?
Special Enrollment Periods (SEPs) allow you to change Medicare Part D or Medicare Advantage plans outside of the annual Open Enrollment Period (AEP) that runs from October 15th through December 7th. But, SEPs are usually granted only for exceptional reasons or circumstances (such as when you move to a new area of the country). However, one of the most accessible Special Enrollment Periods (available in specific areas of the country) is the 5-star Special Enrollment Period. The 5-star SEP allows anyone in the 5-Star plan's service area (ZIP code area) the opportunity to leave their current Medicare plan and join a 5-star rated Medicare Part D or Medicare Advantage plan - at any time during the year - but you can only use this SEP once during the plan year. You can even leave your 5-star rated Medicare plan to join another 5-star plan that may be available in your area.
You can click here to read more about the 5-star Special Enrollment Period - with a few cautions about choosing your 5-star plan. You can click here to read more about other Special Enrollment Periods.
How is it possible that 6 million Medicare beneficiaries can use the 2025 5-star SEP?
In 2025, 5-Star rated Medicare Advantage plans are available in 218 counties across seven (7) states as compared to 1,399 counties across 43 states in 2024. Unfortunately, the only 5-star rated Medicare Part D prescription drug plans (PDPs) are employer/union plans.
Currently*, there are approximately 6,119,361 Medicare beneficiaries enrolled in a Medicare plan that has a star rating of less than 5 stars - and these people are living in counties where a 5-Star rated Medicare Advantage plan is available (MA, MAPD, or SNPs) -- (compared to 28,099,942 in 2024).
(*Using September 2024 CMS Enrollment Data)
More about the 5-star Medicare plans that are available in 2025
The chart below lists the carriers whose Medicare Advantage plans have a 5-Star CMS quality rating for the plan year 2025. Since there are many 5-Star Medicare Advantage plans, we are not able to list each plan individually.
Carriers Offering 5-Star Rated Medicare Advantage Plans (MA, MAPD) |
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| Carrier |
Contract ID |
Nbr of Counties | |
| Alignment Health Plan | H5296 | 68 | |
| Dean Health Plan, Inc. | H5264 | 16 | |
| HealthSun Health Plans, Inc. | H5431 | 14 | |
| Highmark Blue Cross Blue Shield or Highmark Blue Shield | H3957 | 187 | |
| Leon Health, Inc. | H4286 | 5 | |
| MCS Classicare | H5577 | 1181 | |
| Medical Associates Clinic Health Plan of Wisconsin | H5256 | 17 | |
| Network Health Medicare Advantage Plans | H5215 | 134 | |
| Optimum HealthCare, Inc. | H5594 | 119 | |
Once on the state page, you can click on your county to see a list of plans available along with plan highlights and links to plan details, formulary, and star rating details. Any plan marked with the
qualifies for the 2025 5-Star Special Enrollment Period (SEP).Medicare beneficiaries currently enrolled any MA, MAPD, or PDP plan (including people already enrolled in another Medicare plan with 5-star rating) can take advantage of the 5-star Special Enrollment Period. The 5-star rating SEP can only be used one time during the plan year.
Remember: If you are currently enrolled in a stand-alone Medicare Part D plan (PDP) and wish to join a 5-star Medicare Advantage plan (MAPD or SNP), you must also be enrolled in Original Medicare Part A and Part B - and meet the eligibility requirements if the plan is a Special Needs Plan (SNP). Click here to read more about 5-star SEP cautions.
States, County Count, and Number of Medicare Beneficiaries Who Can Take Advantage of a 5-Star Medicare Advantage Plans (MA, MAPD) |
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| State |
Nbr of Counties |
Nbr of People |
|
| FL | 25 | 2,980,798 | |
| IA | 5 | 51,791 | |
| NC | 16 | 444,022 | |
| NV | 2 | 348,947 | |
| PA | 59 | 1,378,449 | |
| PR | 78 | 299,418 | |
| WI | 33 | 615,936 | |