Talk to anyone who’s about to go on Medicare and they’ll tell you that figuring out what plan to choose will make you pull your hair out (which is probably not covered by Medicare). There are so many things to consider, from drug coverage, to copays and coinsurance, emergency room visits, hospital stays, the network of available doctors, the network of available pharmacies, and whether a plan provides any form of dental, vision, or hearing coverage. It can be very confusing.

While you’re doing your own research, you’re also bombarded with a blizzard of mail from every company that wants to sell you a Medicare plan, not to mention all those painfully long TV Commercials telling you that THEY know what’s right for you.

Wouldn’t it be nice if there was a way to compare plans? Well, there is. The Centers for Medicare and Medicaid Services (CMS) has a Medicare Star Rating System which compares all the Part C Medicare Advantage plans and all the Part D prescription drug plans. 5 stars is best and 1 star is the worst based on a plan’s quality of care and customer service.

 

Medicare Advantage Plans are judged on five criteria:

  • Staying healthy. Do plan members have access to checkups, vaccinations, and screening tests that help them stay healthy?
  • Chronic conditions: Do members with chronic conditions get the kinds of tests and treatments typically recommended to them?
  • Member experience: How do plan members rate the ease of seeing specialists and getting appointments quickly?
  • Plan performance: How many complaints does the plan receive? Has its performance gotten better or worse over time? Are members leaving the plan?
  • Customer Service: How well does the plan respond to member requests and appeals?

 

Medicare Part D prescription drug plans are rated on four criteria:

  • Drug safety and pricing: How accurate is the plan’s pricing information? Are members with specific medical conditions prescribed drugs appropriately and safely?
  • Member experience: How do plan members rate the plan?
  • Plan performance: How many complaints does the plan receive? Has its performance gotten better or worse over time? Are members leaving the plan?
  • Customer Service: How well does the plan respond to member requests and appeals?

 

Things to consider

When comparing plans, the star rating is only one factor to look at. Even though a plan has a high star rating, it may not be the right one for you. Your situation is unique and the plan you choose has to meet your requirements for care, coverage, and cost.

Star ratings can change from year to year. CMS is constantly reviewing plans. They update their rankings every October. And that’s a good time to review your plan each year and see if it’s still the best for you, or if you should switch to a different Medicare Advantage Plan or Part D drug plan.

If you’re looking for the current star rating for the plan you have or one you’re considering, you’ll find the star rankings at Medicare Plan Finder. If you’re more comfortable talking to someone on the telephone number is 1-800-MEDICARE.

Generally, switching plans can only take place during certain enrollment periods:

 

Initial Enrollment—This takes place when you’re first eligible for Medicare and runs for 7 months—three months before you turn 65, the month you turn 65, and the three months after the month you turn 65.

Open Enrollment—October 15 to December 7 each year.

General Enrollment—January 1 to March 31 each year, if you already have a Medicare Advantage plan.

 

However, there is the Five-Star Special Enrollment Period (SEP) for people who currently have a plan that is rated lower than 5 stars. If a Medicare Advantage Plan, Medicare drug plan, or Medicare Cost Plan with a 5-star rating is available in your area, you can use the 5-star Special Enrollment Period to switch from your current Medicare plan to a Medicare plan with a “5-star” quality rating. You can use this Special Enrollment Period only once per year between December 8 and November 30 of the following year.

But be careful. If you move from a Medicare Advantage Plan that includes prescription drug coverage to a stand-alone Medicare Prescription Drug Plan, you’ll be disenrolled from your Medicare Advantage Plan, including the health benefit. You’ll be returned to Original Medicare for coverage of your health services. You can only switch to a 5-star Medicare Prescription Drug Plan if one is available in your area.

If you move from a Medicare Advantage Plan that has drug coverage to a 5‑star Medicare Advantage Plan that doesn’t, you may lose your prescription drug coverage. You’ll have to wait until your next enrollment period, Open or General, to get drug coverage, and you may have to pay a Part D late enrollment penalty.

If you enroll during the Five-Star Enrollment Period, enrollments in December are effective January 1. Enrollments from January to November are effective the month following the enrollment request. To use the Five-Star Special Enrollment Period, contact Medicare at 1-800-633-4227.