There are also special rules for people who switch from a Medicare medical savings account (MSA) plan to a Medicare Advantage plan.
Another special enrollment period was added in 2013 for low-performing plans. So individuals on a plan with three stars or fewer for three consecutive years have options. Plans available to your clients could include those with three stars or higher, or those with no rating (i.e., they are too new and unrated).
Next Step For Clients – To Switch Or Not?
The biggest limitation on the five-star special enrollment period is that only a small number of plans receive this top rating.
The National Council on Aging reports that 19 Medicare contracts received a five-star rating for 2014. You may have clients who do not have access to a five-star Medicare Advantage or Part D plan. There are many service areas (even many states) with no five-star plans at all.
The critical question for your clients: Is it worth it to switch to a five-star plan? As with most things, the answer is, “It depends.”
The quality rating is one thing to take into account when choosing a plan. But the rating system alone does not tell you if a plan is a good match for your client’s specific health-care needs.
For example, a Part D prescription drug plan with a five-star rating may not be the best plan for your client if it doesn’t cover a needed drug or if it charges a high co-pay for a crucial drug they use.
But if they are not happy with their coverage because premiums increased unexpectedly, or their doctor left the plan’s network—they may want to use this opportunity to review their options.
The bottom line is that your client should select the plan that provides the best coverage of the care and drugs she needs, while fitting her health-care budget. If the five-star plan is a better match for your client’s needs than what she has now, a switch may be to her advantage.
Turn Quality Ratings to Your Clients’ Advantage
In the wake of the ACA, Medicare quality ratings have taken on greater weight. Plans now have compelling incentives to achieve higher scores on Medicare’s measures of quality.