When Can I Market the 5-Star SEP for the Upcoming Year?


If your clients have a 5-star Medicare Part D Plan or 5-star Medicare Advantage Plan in their service area, it’s a great value. But brokers need to ensure that the rating carries over into the next plan year before marketing it for the 5-star special enrollment period (SEP), which takes place from December 8 to November 30 of the following year. The 5-star SEP, which overlaps with the annual election period (AEP) between October 15 and November 30, allows current enrollees one opportunity to change their plans throughout the year outside of AEP.

For example, your client, Jane, enrolls in a plan in late October during AEP. A few months later, in February, she decides the plan does not meet her needs. Assuming that Jane is eligible, you could use the 5-star SEP to help Jane enroll in a plan that better fits her needs. However, the plan must have a rating of five stars.

Why Does the 5-Star SEP Overlap With the AEP?

The 5-Star SEP allows enrollees to change plans much quicker (the first day of the following month), while the AEP allows for a January 1 start date. The only time the 5-Star SEP is not available is December 1-7, which is also the last week of the AEP. During this time frame, the only available start date for switching plans would be January 1, which the AEP covers. Because of this, having multiple SEPs during this brief period is unnecessary, according to CMS. So, for that missing week, you should market the AEP to your clients.

The 5-Star SEP is available nearly year-round for two reasons, according to CMS:

  • It serves as a reward to high-quality, high-performing health plans.
  • It ensures that beneficiaries have consistent access to high-performing health plans.

When Can Brokers Market the 5-Star SEP for the Upcoming Year?

Brokers can market the 5-star SEP to eligible clients from December 8 of the current year through November 30 of the next calendar year. As noted above, the AEP overlaps with the 5-Star SEP October 15 through November 30. In this timespan, brokers can use either the 5-Star SEP or the AEP for their client’s enrollment needs. (Remember: Your client must switch to a 5-star-rated plan to use the 5-Star SEP.) Outside of the overlapping enrollment periods, the 5-Star SEP gives clients the opportunity to switch to a high-rated plan outside of the AEP.

Can a 5-Star Medicare Plan Lose Its Rating?

Yes, plan ratings can change. Every fall, Medicare updates the star ratings to help consumers chose a new plan in time for the annual enrollment period (AEP). If you have a plan that will lose its 5-star rating in the upcoming plan year, you cannot market it for the 5-star SEP after November 30, according to CMS’ rules (Medicare Marketing Guidelines, Section 40.6.1). On the upside, a new 5-star Medicare plan might be available in the upcoming plan year that wasn’t before.

Why Does the 5-Star SEP Exist?

CMS’ started its Star Ratings program more than a decade ago with two main goals in mind:

  • Motivate health insurance plans to improve their MA plan offerings
  • Encourage customers to enroll in these high-quality plans

Through this program, CMS releases comprehensive data on MA plan performance each October, allowing a more transparent look at the available options. Since the implementation of CMS’ Star Ratings program, MA plans have become more efficient and overall ratings have risen, according to a study by McKinsey & Company.

Where Can I Get More Medicare Marketing Guidance?

Our resource center is available 24/7 to give you the help you need with Medicare Marketing Guidelines topics such as providing SEP information and 5-Star SEP. To learn more about the Excelsior team and how we can help you double, or triple, your income, contact us.


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References
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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