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Selling 5 Star Medicare Plans

By  Senior Market Advisors  on April 1, 2019

There are 3,959 Medicare Advantage plans on the market nationwide in 2024. Based on location and eligibility, the average enrollee has 43 plan options, but only 10% of beneficiaries are enrolled in 5 star Medicare plans. Selling these plans is a great opportunity to build your book of business outside of AEP.

What is a Medicare 5 star rating?

The Centers for Medicare and Medicaid Services (CMS) uses a rating system to rate Medicare Advantage and Part D plans, with five stars being the highest and one the lowest. If a plan receives a rating below three stars for three consecutive years, it will be flagged by CMS. If the plan continues to rate poorly, it may be removed entirely from the marketplace. In 2024, most beneficiaries can enroll in a Medicare Advantage or Part D plan with four or more stars.

Medicare Advantage and Part D may have the same star system, but they have different factors that are weighted in the rating process. Medicare Advantage plans are rated on the following factors:

  • Level of access to preventive services (including annual physical exams and screenings)
  • Care coordination
  • How often members receive treatment for long-term conditions
  • Current member satisfaction
  • Plan performance in comparison to the previous year
  • Customer service quality

Part D plans are rated on the following:

  • Number of member issues with the plan
  • How many people left over one year
  • Patient safety while using prescriptions in the plan
  • Accuracy of pricing

5 Star Medicare Plans Special Enrollment

If beneficiaries do not currently have top-rated Medicare Advantage plans available in their zip code, and a new plan becomes available, they can switch from their current plan to a 5 star plan even if it is not AEP. This means that they have a SEP that lasts from December 8 to November 20 of the following year. During this time, beneficiaries can:

  • Switch from Original Medicare to a 5 star plan
  • Change from a lower-rated plan to a 5 star plan
  • Switch between different 5 star plans

You may have noticed that the 5 Star SEP overlaps with AEP, but why?

The SEP allows enrollees to change plans quickly with a start date of the following month, while AEP creates a January 1 start date. According to CMS, the 5 star SEP is nearly year-around because it serves as a reward to enroll in a high quality and performing plan, and it ensures beneficiaries have consistent access to these plans.

Sell 5 Star Medicare Plans

As an agent, you can market enrollments under the 5 star SEP for plans that have a 5 star rating, but you cannot market enrollments that no longer have a 5 star rating. We know compliance guidelines can get confusing, but at Senior Market Advisors, we make sure our agents are up to date on any regulations or policies.

We also offer a compliance team, in-house marketing team, custom-built CRM system, Medicare Supplement quote engine, in-house marketing team, and so much more.

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