Powered by Q1Group LLC
Education and Decision Support Tools for the Medicare Community


Over Thirteen million people can take advantage of the 2020 "5-Star" Medicare plan Special Enrollment Period.

Category: Star Ratings & Plan Quality
Published on 2020-03-30 14:25:24


Over 13 million people have access to 2020 Medicare Part D plans and Medicare Advantage plans with a 5-Star quality rating - and this means these people have the option of using a once-a-year Special Enrollment Period (SEP) to change to a 5-Star Medicare plan during the year.

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 Service Area the opportunity to leave their current Medicare plan and join a 5-star Medicare Part D or Medicare Advantage plan - at any time during the 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 13 million Medicare beneficiaries can use the 2020 5-star SEP?
In 2020, 5-star rated Medicare Part D prescription drug plans (PDPs) are available in all counties in four states and 5-Star rated Medicare Advantage plans are available in 299 counties across 18 states.

Currently*, there are approximately 12,391,523 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).

A total of 1,317,137 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.

(*Using January 2020 CMS Enrollment Data)

More about the 5-star Medicare plans that are available in 2020
The charts below lists the Medicare Part D and Medicare Advantage plans that have a 5-Star CMS quality rating for the plan year 2020.

You can click on the plan name to see plan details including service area, link to formulary (drug list) and enrollment options.

The plans below all qualify for the 2020 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.   You can click here to read more about the 5-star SEP.

Remember:  If you are currently enrolled in a Medicare Advantage plan (MA or MAPD), and you join a 5-star stand-alone prescription drug plan (PDP), you will be disenrolled from your Medicare Advantage plan and returned to Original Medicare Part A and Part B -- along with your new prescription drug plan.

5-Star Rated
Stand-Alone Medicare Part D Prescription Drug Plans (PDP)
State Carrier Plan Name (Plan ID)
CT MA RI VT Anthem Blue Cross and Blue Shield Blue MedicareRx Premier (PDP) (S2893-003)
CT MA RI VT Anthem Blue Cross and Blue Shield Blue MedicareRx Value Plus (PDP) (S2893-001)


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 for the Medicare Advantage plan.  Click here to read more about 5-star SEP cautions.

5-Star Rated
Medicare Advantage Plans (MA, MAPD)

State

Carrier

Plan Name (Plan ID)
Nbr of Counties
CA Kaiser Permanente Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) - (H0524-003-0) 2
CA Kaiser Permanente Kaiser Permanente Senior Advantage Solano (HMO) - (H0524-008-0) 1
CA Kaiser Permanente Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO) - (H0524-013-0) 8
CA Kaiser Permanente Kaiser Permanente Senior Advantage Inland Empire (HMO) - (H0524-015-0) 2
CA Kaiser Permanente Senior Advantage Medicare Medi-Cal Plan South (HMO D-SNP) - (H0524-029-0) 7
CA Kaiser Permanente Senior Advantage Medicare Medi-Cal Plan North (HMO D-SNP) - (H0524-030-0) 24
CA Kaiser Permanente Kaiser Permanente Senior Advantage Marin San Mateo (HMO) - (H0524-031-0) 2
CA Kaiser Permanente Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO) - (H0524-032-0) 3
CA Kaiser Permanente Kaiser Permanente Senior Advantage Contra Costa (HMO) - (H0524-033-0) 1
CA Kaiser Permanente Kaiser Permanente Senior Advantage Ventura (HMO) - (H0524-034-0) 1
CA Kaiser Permanente Kaiser Permanente Senior Advantage Enhanced Kern (HMO) - (H0524-035-0) 1
CA Kaiser Permanente Kaiser Permanente Senior Advantage Basic Kern (HMO) - (H0524-036-0) 1
CA Kaiser Permanente Kaiser Permanente Senior Advantage San Diego (HMO) - (H0524-037-0) 1
CA Kaiser Permanente Kaiser Permanente Senior Advantage Enhanced Fresno (HMO) - (H0524-038-0) 5
CA Kaiser Permanente Kaiser Permanente Senior Advantage Santa Clara (HMO) - (H0524-039-0) 1
CA Kaiser Permanente Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) - (H0524-040-0) 1
CA Kaiser Permanente Kaiser Permanente Senior Advantage Basic Stanis (HMO) - (H0524-041-0) 1
CA Kaiser Permanente Kaiser Permanente Senior Advantage Enhanced SnJoaq (HMO) - (H0524-042-0) 1
CA Kaiser Permanente Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) - (H0524-043-0) 1
CA Kaiser Permanente Kaiser Permanente Senior Advantage Basic Fresno (HMO) - (H0524-046-0) 5
CA Kaiser Permanente Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) - (H0524-051-0) 8
CA Kaiser Permanente Kaiser Permanente Senior Advantage Santa Cruz (HMO) - (H0524-054-0) 1
CO Kaiser Permanente Kaiser Permanente Senior Advantage Core (HMO) - (H0630-013-0) 10
CO Kaiser Permanente Senior Advantage Medicare Medicaid (HMO D-SNP) - (H0630-014-0) 10
CO Kaiser Permanente Kaiser Permanente Senior Advantage Silver (HMO) - (H0630-015-0) 10
CO Kaiser Permanente Kaiser Permanente Senior Advantage Gold (HMO) - (H0630-016-0) 10
CO Kaiser Permanente Kaiser Permanente Senior Advantage Core (HMO) - (H0630-017-0) 2
CO Kaiser Permanente Kaiser Permanente Senior Advantage Core (HMO) - (H0630-020-0) 2
CO Kaiser Permanente Kaiser Permanente Senior Advantage Silver (HMO) - (H0630-021-0) 2
DC Kaiser Permanente Kaiser Permanente Medicare Advantage High DC (HMO) - (H2172-001-0) 1
DC Kaiser Permanente Kaiser Permanente Medicare Advantage Standard DC (HMO) - (H2172-003-0) 1
DC Kaiser Permanente Kaiser Permanente Medicare Advantage w/o Part D (HMO) - (H2172-005-0) 1
FL CarePlus Health Plans, Inc. CareOne (HMO) - (H1019-001-0) 1
FL CarePlus Health Plans, Inc. CareOne PLUS (HMO) - (H1019-006-0) 1
FL CarePlus Health Plans, Inc. CareNeeds PLUS (HMO D-SNP) - (H1019-023-0) 2
FL CarePlus Health Plans, Inc. CareNeeds PLUS (HMO D-SNP) - (H1019-024-0) 1
FL CarePlus Health Plans, Inc. CareNeeds PLUS (HMO D-SNP) - (H1019-026-0) 4
FL CarePlus Health Plans, Inc. CareNeeds PLUS (HMO D-SNP) - (H1019-028-0) 6
FL CarePlus Health Plans, Inc. CareOne (HMO) - (H1019-043-0) 2
FL CarePlus Health Plans, Inc. CareOne PLUS (HMO) - (H1019-057-0) 6
FL CarePlus Health Plans, Inc. CareFree (HMO) - (H1019-065-0) 2
FL CarePlus Health Plans, Inc. CareOne (HMO) - (H1019-069-0) 2
FL CarePlus Health Plans, Inc. CareNeeds PLUS (HMO D-SNP) - (H1019-073-0) 2
FL CarePlus Health Plans, Inc. CareFree PLUS (HMO) - (H1019-076-0) 1
FL CarePlus Health Plans, Inc. CareNeeds (HMO D-SNP) - (H1019-077-0) 6
FL CarePlus Health Plans, Inc. CareNeeds (HMO D-SNP) - (H1019-079-0) 4
FL CarePlus Health Plans, Inc. CareNeeds (HMO D-SNP) - (H1019-081-0) 2
FL CarePlus Health Plans, Inc. CareNeeds (HMO D-SNP) - (H1019-083-0) 1
FL CarePlus Health Plans, Inc. CareNeeds (HMO D-SNP) - (H1019-085-0) 2
FL CarePlus Health Plans, Inc. CareExtra (HMO) - (H1019-089-0) 1
FL CarePlus Health Plans, Inc. CareNeeds PLUS (HMO D-SNP) - (H1019-090-0) 2
FL CarePlus Health Plans, Inc. CareNeeds (HMO D-SNP) - (H1019-091-0) 2
FL CarePlus Health Plans, Inc. CareFree (HMO) - (H1019-092-0) 6
FL CarePlus Health Plans, Inc. CareFree (HMO) - (H1019-094-0) 1
FL CarePlus Health Plans, Inc. CareOne PLUS (HMO) - (H1019-098-0) 1
FL CarePlus Health Plans, Inc. CareFree (HMO) - (H1019-099-0) 1
FL CarePlus Health Plans, Inc. CareNeeds PLUS (HMO D-SNP) - (H1019-100-0) 1
FL CarePlus Health Plans, Inc. CareNeeds (HMO D-SNP) - (H1019-101-0) 1
FL CarePlus Health Plans, Inc. CareOne (HMO) - (H1019-102-0) 1
FL CarePlus Health Plans, Inc. CareOne PLUS (HMO) - (H1019-103-1) 1
FL CarePlus Health Plans, Inc. CareOne PLUS (HMO) - (H1019-103-2) 3
FL CarePlus Health Plans, Inc. CareFree (HMO) - (H1019-104-1) 1
FL CarePlus Health Plans, Inc. CareFree (HMO) - (H1019-104-2) 3
FL Florida Blue HMO FHCP Medicare Rx Plus (HMO-POS) - (H1035-002-0) 2
FL Florida Blue HMO FHCP Medicare Rx (HMO) - (H1035-006-0) 2
FL Florida Blue HMO FHCP Medicare Premier Plus (HMO) - (H1035-011-0) 2
FL Florida Blue HMO FHCP Medicare Rx Savings (HMO) - (H1035-014-0) 2
FL Florida Blue HMO FHCP Medicare Flagler Advantage (HMO) - (H1035-016-0) 1
FL Florida Blue HMO BlueMedicare Classic (HMO) - (H1035-017-0) 1
FL Florida Blue HMO BlueMedicare Classic (HMO) - (H1035-018-0) 1
FL Florida Blue HMO BlueMedicare Classic (HMO) - (H1035-019-0) 19
FL Florida Blue HMO BlueMedicare Classic (HMO) - (H1035-020-0) 3
FL Florida Blue HMO BlueMedicare Classic (HMO) - (H1035-021-0) 4
FL Florida Blue HMO BlueMedicare Classic Plus (HMO) - (H1035-022-0) 1
FL Florida Blue HMO BlueMedicare Classic Plus (HMO) - (H1035-023-0) 2
FL Florida Blue HMO BlueMedicare Premier (HMO) - (H1035-024-0) 1
FL Florida Blue HMO BlueMedicare Premier (HMO) - (H1035-025-0) 1
FL Florida Blue HMO BlueMedicare Premier (HMO) - (H1035-026-0) 2
FL Florida Blue HMO BlueMedicare Complete (HMO D-SNP) - (H1035-027-0) 1
FL Florida Blue HMO BlueMedicare Complete (HMO D-SNP) - (H1035-028-0) 2
FL Florida Blue HMO BlueMedicare Complete (HMO D-SNP) - (H1035-029-0) 2
FL Florida Blue HMO BlueMedicare Complete (HMO D-SNP) - (H1035-030-0) 2
FL Florida Blue HMO BlueMedicare Complete (HMO D-SNP) - (H1035-031-0) 2
FL Florida Blue HMO BlueMedicare Complete (HMO D-SNP) - (H1035-032-0) 1
FL Florida Blue HMO BlueMedicare Premier (HMO) - (H1035-033-0) 2
FL Florida Blue HMO BlueMedicare Premier (HMO) - (H1035-034-0) 1
FL Florida Blue HMO BlueMedicare Saver (HMO) - (H1035-035-0) 1
FL Florida Blue HMO BlueMedicare Saver (HMO) - (H1035-037-0) 3
FL Florida Blue HMO BlueMedicare Saver (HMO) - (H1035-038-0) 2
FL Florida Blue HMO BlueMedicare Saver (HMO) - (H1035-039-0) 1
FL Florida Blue HMO FHCP Medicare Premier Advantage (HMO) - (H1035-040-0) 2
FL HealthSpring of Florida, Inc. Leon Medical Centers Health Plans - Leon Cares (HMO) - (H5410-001-0) 1
FL HealthSpring of Florida, Inc. Cigna-HealthSpring Advantage (HMO) - (H5410-004-0) 5
FL HealthSpring of Florida, Inc. Cigna-HealthSpring TotalCare (HMO D-SNP) - (H5410-013-0) 5
FL HealthSpring of Florida, Inc. Cigna-HealthSpring Preferred (HMO) - (H5410-018-0) 5
FL HealthSpring of Florida, Inc. Cigna-HealthSpring Preferred (HMO) - (H5410-024-0) 5
FL HealthSpring of Florida, Inc. Cigna-HealthSpring TotalCare (HMO D-SNP) - (H5410-025-0) 5
FL HealthSpring of Florida, Inc. Cigna-HealthSpring Preferred Part B Savings (HMO) - (H5410-026-0) 5
FL HealthSpring of Florida, Inc. Cigna-HealthSpring Preferred (HMO) - (H5410-027-0) 2
FL HealthSpring of Florida, Inc. Cigna-HealthSpring Preferred Part B Savings (HMO) - (H5410-028-0) 2
FL HealthSpring of Florida, Inc. Cigna-HealthSpring Preferred (HMO) - (H5410-029-0) 4
FL HealthSpring of Florida, Inc. Cigna-HealthSpring Preferred Part B Savings (HMO) - (H5410-030-0) 4
FL HealthSpring of Florida, Inc. Cigna-HealthSpring TotalCare (HMO D-SNP) - (H5410-031-0) 2
FL HealthSpring of Florida, Inc. Cigna-HealthSpring TotalCare (HMO D-SNP) - (H5410-032-0) 4
FL HealthSpring of Florida, Inc. Cigna-HealthSpring Primary (HMO) - (H5410-033-0) 5
FL HealthSpring of Florida, Inc. Cigna-HealthSpring Primary (HMO) - (H5410-034-0) 2
FL HealthSpring of Florida, Inc. Cigna-HealthSpring Primary (HMO) - (H5410-035-0) 4
FL HealthSun Health Plans, Inc. HealthSun SunPlus Advantage Plan (HMO) - (H5431-001-0) 1
FL HealthSun Health Plans, Inc. HealthSun MediMax (HMO) - (H5431-006-0) 2
FL HealthSun Health Plans, Inc. HealthSun HealthAdvantage Plan (HMO) - (H5431-012-0) 1
FL HealthSun Health Plans, Inc. HealthSun HealthAdvantage Plan (HMO) - (H5431-013-0) 1
FL HealthSun Health Plans, Inc. HealthSun MediMax (HMO) - (H5431-014-0) 1
GA Kaiser Permanente Kaiser Permanente Senior Advantage Enhanced (HMO) - (H1170-002-0) 12
GA Kaiser Permanente Senior Advantage Medicare Medicaid Plan (HMO D-SNP) - (H1170-008-0) 12
GA Kaiser Permanente Kaiser Permanente Senior Advantage Basic (HMO) - (H1170-009-0) 12
GA PruittHealth Premier PruittHealth Premier (HMO I-SNP) - (H3291-001-0) 37
GA PruittHealth Premier PruittHealth Premier D-SNP (HMO D-SNP) - (H3291-002-0) 13
HI Kaiser Permanente Kaiser Permanente Senior Advantage Enhanced (HMO) - (H1230-001-0) 1
HI Kaiser Permanente Kaiser Permanente Senior Advantage Basic (HMO) - (H1230-003-0) 1
HI Kaiser Permanente Senior Advantage Medicare Medicaid (HMO D-SNP) - (H1230-008-0) 2
HI Kaiser Permanente Kaiser Permanente Senior Advantage Maui (HMO) - (H1230-013-0) 1
HI Kaiser Permanente Kaiser Permanente Senior Advantage Hawaii Island (HMO) - (H1230-014-0) 1
IA Medical Associates Health Plan, Inc. Medical Associates SmartPlan (Cost) - (H1651-001-0) 5
IA Medical Associates Health Plan, Inc. Medical Associates Basic Plan (Cost) - (H1651-002-0) 5
IA Medical Associates Health Plan, Inc. Medical Associates Community Plan (Cost) - (H1651-004-0) 5
IA Medical Associates Health Plan, Inc. Medical Associates Freedom Plan (Cost) - (H1651-008-0) 5
IA Medical Associates Health Plan, Inc. MercyOne Cedar Valley Senior Plan (Cost) - (H1651-010-0) 8
IA Medical Associates Health Plan, Inc. Central Iowa Health Senior Plan (Cost) - (H1651-011-0) 23
IA Medical Associates Health Plan, Inc. MercyOne Clinton Community Senior Plan (Cost) - (H1651-012-0) 4
IA Medical Associates Health Plan, Inc. Quad Cities Community Health Senior Plan (Cost) - (H1651-013-0) 5
IA Medical Associates Health Plan, Inc. Mercy Cedar Rapids Senior Plan (Cost) - (H1651-014-0) 8
IA Medical Associates Health Plan, Inc. MercyOne North Iowa Senior Plan (Cost) - (H1651-015-0) 13
IA Medical Associates Health Plan, Inc. Mercy Iowa City Senior Plan (Cost) - (H1651-016-0) 5
IA Medical Associates Health Plan, Inc. Omaha Community Senior Plan (Cost) - (H1651-022-0) 9
IA Medical Associates Health Plan, Inc. MercyOne Siouxland Senior Plan (Cost) - (H1651-024-0) 5
IA Senior Preferred Gundersen Senior Preferred Elite (w/Rx) (HMO) - (H5262-001-0) 5
IA Senior Preferred Gundersen Senior Preferred Value (w/Rx) (HMO) - (H5262-003-0) 5
IA Senior Preferred Gundersen Senior Preferred Value (no Rx) (HMO) - (H5262-004-0) 5
IA Senior Preferred Gundersen Senior Preferred Elite (no Rx) (HMO) - (H5262-005-0) 5
IA Senior Preferred Gundersen Senior Preferred Core (w/Rx) (HMO) - (H5262-021-0) 5
IL Medical Associates Health Plan, Inc. Medical Associates SmartPlan (Cost) - (H1651-003-0) 1
IL Medical Associates Health Plan, Inc. Medical Associates Community Plan (Cost) - (H1651-005-0) 1
IL Medical Associates Health Plan, Inc. Medical Associates Freedom Plan (Cost) - (H1651-009-0) 1
IL Medical Associates Health Plan, Inc. Quad Cities Community Health Senior Plan (Cost) - (H1651-017-0) 1
IL Senior Preferred SwedishAmerican Senior Preferred Elite (w/Rx) (HMO) - (H5262-018-0) 1
IL Senior Preferred SwedishAmerican Senior Preferred Value (w/Rx) (HMO) - (H5262-019-0) 1
IL Senior Preferred SwedishAmerican Senior Preferred Elite (no Rx) (HMO) - (H5262-020-0) 1
MA Tufts Health Plan Tufts Medicare Preferred HMO Prime Rx Plus (HMO) - (H2256-001-1) 2
MA Tufts Health Plan Tufts Medicare Preferred HMO Prime Rx Plus (HMO) - (H2256-001-2) 5
MA Tufts Health Plan Tufts Medicare Preferred HMO Prime Rx Plus (HMO) - (H2256-001-6) 2
MA Tufts Health Plan Tufts Medicare Preferred HMO Prime Rx (HMO) - (H2256-015-1) 2
MA Tufts Health Plan Tufts Medicare Preferred HMO Prime Rx (HMO) - (H2256-015-2) 5
MA Tufts Health Plan Tufts Medicare Preferred HMO Prime Rx (HMO) - (H2256-015-6) 2
MA Tufts Health Plan Tufts Medicare Preferred HMO Prime No Rx (HMO) - (H2256-016-1) 2
MA Tufts Health Plan Tufts Medicare Preferred HMO Prime No Rx (HMO) - (H2256-016-2) 5
MA Tufts Health Plan Tufts Medicare Preferred HMO Value Rx (HMO) - (H2256-018-1) 2
MA Tufts Health Plan Tufts Medicare Preferred HMO Value Rx (HMO) - (H2256-018-7) 5
MA Tufts Health Plan Tufts Medicare Preferred HMO Value Rx (HMO) - (H2256-018-8) 2
MA Tufts Health Plan Tufts Medicare Preferred HMO Value No Rx (HMO) - (H2256-019-1) 2
MA Tufts Health Plan Tufts Medicare Preferred HMO Value No Rx (HMO) - (H2256-019-7) 5
MA Tufts Health Plan Tufts Medicare Preferred HMO Basic Rx (HMO) - (H2256-026-1) 2
MA Tufts Health Plan Tufts Medicare Preferred HMO Basic Rx (HMO) - (H2256-026-2) 5
MA Tufts Health Plan







Medicare Supplements
fill the gaps in your
Original Medicare
1. Enter Your ZIP Code:
» Medicare Supplement FAQs




Ask a Pharmacist*
Have questions about your medication?

» Answers to Your Medication Questions, Free!
Available Monday - Friday
8am to 5pm MST
*A free service included with your no cost drug discount card.




Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.