Questions and Answers about the Special Enrollment Period for 5-Star Rated Medicare Plans

Question: My insurance agent told me that I could get out of my current Medicare Advantage plan and join a Medicare plan with a “5-star” rating anytime during 2012.

Yes, if a 5-star rated plan is available in your service area. Starting this year, there is a new Special Enrollment Period (or SEP) that allows people a one-time chance to switch from their current Medicare plan to a Medicare plan with a "5 Star" quality rating at any time during the 2012 plan year (up to November 30th). 5-Star plans are available for stand-alone Medicare Part D plans and Medicare Advantage plans. As a note, if you are currently enrolled in a Medicare Advantage plan and decide to join a 5-Star Medicare Part D plan (a plan that only provides prescription drugs drug coverage), you would automatically be dis-enrolled from your Medicare Advantage plan and go back to your Original Medicare coverage along with your newly selected Medicare Part D prescription drug plan. You can click here to read more about the 5-Star Special Enrollment Period.

Question: I want to change to one of the 5-Star Medicare Part D plans, are they available in every state?

No. "5 Star" Medicare Part D and Medicare Advantage plans are available only in a limited number of states across the country. Currently, the only "5 Star" stand-alone Medicare Part D prescription drug plans (or PDPs) available in 2012 are the:

EXCELLUS HEALTH plans – statewide in New York, and
WELLMARK Blue Cross Blue Shield plans – statewide in IA, MN, MT, NE, ND, SD, and WY.

The 5-Star Medicare Advantage plans available in 2012 are:

Kaiser – select counties in CA, CO, HI, OR and WA;
Group Health Cooperative – select counties in WA;
Gundersen Lutheran Health Plan – select counties in IA and WI;
Martin’s Point Generations – select counties in ME; and
Providence Health Plans – select counties in OR and WA.

So if you do not live in select counties in California (30 counties), Colorado (17 counties), Hawaii (3 counties), Iowa (5 counties), Maine (16 counties), Oregon (10 counties), Washington (16 counties), Wisconsin (11 counties) for Medicare Advantage plans - or statewide in New York, Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota, Wyoming for stand-alone Medicare Part D prescription drug plans, you cannot take advantage of the "5 Star" Special Enrollment Period in 2012.The number of 5-Star rated plans can change each year and we expect to see a wider selection of 5-Star plans in 2013, as plans strive to increase their overall plan quality ratings.