How did we arrive at 11 million people?
In 2017, 5-star rated Medicare Part D plans are available across all counties in 12 states and 5-Star rated Medicare Advantage plans are available in 261 counties across 18 states (see chart below for more details).
Currently, there are approximately 9,240,000 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 Medicare Advantage plan is available (MA, MAPD, or SNPs).
Also, an additional 3,740,000 Medicare beneficiaries are enrolled in a Medicare plan that has a star rating of less than 5 stars and are living in states where a 5-star stand-alone Medicare Part D prescription drug plan (PDP) is available, but these people are not enrolled in the 5-star plan.
This means that a total of over 11,500,000 Medicare beneficiaries could take advantage of the 5-Star Special Enrollment Period and change their Medicare plan coverage at this time.
A little background: What is the 5-Star Special Enrollment Period?
Special Enrollment Periods (SEPs) allow you to change Medicare plans outside of the annual Open Enrollment Period (AEP) that runs from October 15th through December 7th and are granted only for exceptional reasons. You can click here to read more about Special Enrollment Periods. And one relatively new Special Enrollment Period available in specific areas of the country is the 5-star Special Enrollment Period. The 5-star SEP allows you the opportunity to leave your 2017 Medicare plan and join a 5-star Medicare Part D or Medicare Advantage plan anytime during the year. You can click here to read more about the 5-star Special Enrollment Period - with a few cautions about choosing your 5-star plan.
The 5-Star stand-alone Medicare Part D plans available in 2017
There are six 5-Star rated stand-alone Medicare Part D prescription drug plans (PDPs) offered in 2017. These plans include the:
- Anthem Blue Cross and Blue Shield - Blue MedicareRx Premier (PDP) and Blue MedicareRx Value Plus (PDP) plans in
Connecticut,
Massachusetts,
Rhode Island, and
Vermont.
- Wellmark Blue Cross and Blue Shield of Iowa - MedicareBlue Rx Premier (PDP) and MedicareBlue Rx Standard (PDP) plans in
Iowa,
Minnesota,
Montana,
Nebraska,
North Dakota,
South Dakota, and
Wyoming.
- Blue Cross Blue Shield of Michigan - Prescription Blue Option A (PDP) and Prescription Blue Option B (PDP) available in Michigan.
A 5-star stand-alone Medicare Part D prescription drug plan (PDP) is available statewide in
- Connecticut - currently 229,047 people enrolled in Connecticut PDP plans with less than 5 stars,
- Iowa - currently 259,559 people enrolled in Iowa PDP plans with less than 5 stars,
- Massachusetts - currently 438,093 people enrolled in Massachusetts PDP plans with less than 5 stars,
- Michigan - 601,375 people enrolled in Michigan PDP plans with less than 5 stars,
- Minnesota - currently 285,782 members enrolled in Minnesota PDP plans with less than 5 stars,
- Montana - 80127 people enrolled in Montana PDP plans with less than 5 stars,
- Nebraska - currently 156,511 people enrolled in Nebraska PDP plans with less than 5 stars,
- North Dakota - 59,875 people enrolled in North Dakota PDP plans with less than 5 stars,
- Rhode Island - currently 57755 people enrolled in Rhode Island PDP plans with less than 5 stars,
- South Dakota - currently 81,828 members enrolled in South Dakota PDP plans with less than 5 stars,
- Vermont - currently 69,997 people enrolled in Vermont PDP plans with less than 5 stars,
- Wyoming - currently 49,826 members enrolled in Wyoming PDP plans with less than 5 stars.
In other words, there are 2,370,000 people enrolled a stand-alone Medicare Part D prescription drug plan that has a less than 5-star rating in states where a 5-star rated plan is available.
These members are all eligible for the 5-star Special Enrollment Period.
- AARP MedicareComplete HMO plans in select
Texas counties.
- Erickson Advantage HMO-POS and HMO-POS SNP plans in select
Colorado,
Kansas,
Maryland,
Massachusetts,
Michigan,
New Jersey,
Pennsylvania,
Texas,
Virginia, counties.
- Gundersen Senior Preferred HMO Plans offered in select counties in
Iowa and
Wisconsin.
- HealthPartners Cost plans in most
Minnesota and some
Wisconsin counties.
- Kaiser Foundation Cost plan available in select counties in
Washington, DC,
Maryland,
Virginia.
- Kaiser Foundation HMO and HMO-SNP plans in most
California,
Colorado,
Oregon and
Washington State counties.
- KelseyCare HMO and HMO-POS plans in select
Texas counties.
- Blue Cross Blue Shield of Massachusetts HMO and HMO-POS plans in
Massachusetts.
- Optimum HealthCare, Inc. HMO and HMO-POS plans in many
Florida counties.
- PrimeTime Health Plan HMO-POS plans in select
Ohio counties.
- Senior Preferred HMO-POS plans in
Waukesha County, WI.
- Tufts Health Plan HMO & HMO SNP plans in
Massachusetts.
- Senior Preferred HMO plans in Dane County, WI.
The following California counties combined have 2,774,126 members not in 5-Star plans although two (2) or three (3) 5-Star Medicare plans are available depending on the county: Alameda, Amador, Contra Costa, El Dorado, Fresno, Kern, Kings, Los Angeles, Madera, Marin, Mariposa, Napa, Orange, Placer, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara, Solano, Sonoma, Stanislaus, Sutter, Tulare, Ventura, Yolo, and Yuba counties.
The following Colorado counties combined have 344,641 members not already enrolled in a 5-star Medicare plan although two (2), four (4), or nine (9) 5-Star Medicare plans are available depending on the county: Adams, Arapahoe, Boulder, Broomfield, Clear Creek, Denver, Douglas, Elbert, El Paso, Fremont, Gilpin, Jefferson, Larimer, Park, Pueblo, Teller, and Weld counties.
The District of Columbia has 43,619 members not in 5-star plans although six (6) plans are available in the District of Columbia.
The following Florida counties combined have 2,352,534 members not in 5-star plans although two(2) to seven (7) plans are available depending on the county: Brevard, Broward, Charlotte, Citrus, Collier, Hernando, Hillsborough, Indian River, Lake, Lee, Manatee, Marion, Martin, Miami-Dade, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, St. Lucie, Sarasota, Seminole, Sumter, and Volusia counties.
Allamakee County, Iowa has 1,675 members not in 5-star plans although there are four (4) plans are available in Allamakee County.
Johnson County, Kansas has 58,510 members not in 5-star plans although there are five (5) plans are available in Johnson County.
The following Massachusetts counties combined have 555,654 members not in 5-star plans although three (3) to 17 plans are available depending on the county: Barnstable, Bristol, Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, and Worcester counties.
The following Maryland counties combined have 338,995 members not in 5-star plans although six (6) or 11 plans are available depending on the county: Anne Arundel, Baltimore, Calvert, Carroll, Charles, Frederick, Harford, Howard, Montgomery, Prince George's, Queen Anne's counties, and Baltimore City.
Oakland County, Michigan has 115,319 members not in 5-star plans although five (5) plans are available in Oakland County.
Minnesota has 708,410 members not in 5-star plans although 10 plans are available in all counties. Example: Hennepin County.
Monmouth and Morris counties in New Jersey combined have 107,094 members not in 5-star plans although five (5) plans are available in Monmouth and Morris counties.
The following Ohio counties combined have 267,455 members not in 5-star plans although four (4) plans are available depending on the county: Carroll, Columbiana, Harrison, Holmes, Mahoning, Medina, Portage, Stark, Summit, Trumbull, Tuscarawas, and Wayne counties.
The following Oregon counties combined have 237,427 members not in 5-star plans although two (2) plans are available in these counties: Benton, Clackamas, Columbia, Linn, Marion, Multnomah, Polk, Washington, and Yamhill counties.
Bucks and Delaware counties in Pennsylvania combined have 137,413 members not in 5-star plans although five (5) plans are available in Bucks and Delaware counties.
The following Texas counties combined have 809,536 members not in 5-star plans although one (1) to 10 plans are available depending on the county: Aransas, Austin, Brazoria, Cameron, Collin, El Paso, Fort Bend, Galveston, Hardin, Harris, Hays, Hidalgo, Jefferson, Kleberg, Liberty, Montgomery, Nueces, San Patricio, Travis, Willacy, and Williamson counties.
The following Virginia counties combined have 89,342 members not in 5-star plans although six (6) or 11 plans are available depending on the county: Arlington, Fairfax, Loudoun, and Prince William counties, and Alexandria City, Fairfax City, Falls Church City, Manassas City, and Manassas Park City.
The following Washington State counties combined have 63,474 members not in 5-star plans although two (2) plans are available in the following counties: Clark, Cowlitz, Lewis, and Wahkiakum counties.
The following Wisconsin counties combined have 164,402 members not in 5-star plans although three (3) or four (4) plans are available depending on the county: Barron, Burnett, Crawford, Dane, Douglas, Dunn, Jackson, La Crosse, Monroe, Pierce, Polk, St. Croix, Trempealeau, Vernon, Washburn, and Waukesha counties.