What Are the Limitations When Marketing 5-Star SEPs?

infographic explaining the Medicare Marketing Guidelines for 5-Star SEPs

Medicare plans with a 5-star rating are excellent health plans for seniors. But CMS has rules on how you can market 5-star Special Enrollment Periods (SEPs) to Medicare enrollees.

Medicare health and drug plans are evaluated every year. Ratings are announced in the fall just before the annual enrollment period (AEP), which kicks off October 15 and runs through December 7. During AEP, many consumers may not be aware that a new 5-star-rated plan is available or that their existing 5-star plan was downgraded for the upcoming plan year. Giving your clients an extra opportunity to sign up for a 5-star plan is a great advantage. But there are limits on how to let your clients know an SEP is available, according to CMS rules (MMG, Section 30.10.2).

What Are the 5-Star Plan Marketing Limitations?

You can let your senior clientele know that SEPs are available and that you can enroll them in a 5-star plan if they’d like to switch. But you can’t reach out to specific clients who are enrolled in lower-rated plans. In addition, you can’t ask your clients to request an SEP. When in doubt, keep your communications brief and informative, then direct prospects and clients to call you for more information.

How Are Medicare Plans Rated?

CMS rates plans across a variety of broad categories. Health plans are evaluated on quality of care, overall customer service, member complaint handling, chronic disease management, and preventative health. Prescription drug plans are rated on drug safety, accuracy of pricing, member complaint handling, and overall customer service.

Where Can I Get More Medicare Marketing Guidance?

Our resource center is available 24/7 to give you the help you need with Medicare guidelines, sales advice and more to keep your business on track. To learn more about the Excelsior team and how we can help you, contact us.

Note: For the most current information, see the CMS Medicare Marketing Guidelines.


https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/five-star-enrollment/5-star-enrollment-period.html | https://www.cms.gov/Outreach-and-Education/Training/CMSNationalTrainingProgram/Downloads/2015-5-Star-Plan-Ratings-Overview-Job-Aid.pdf

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