When it comes to Medicare Advantage, not all plans are created equal. Some plans go above and beyond, offering top-quality care, strong customer service, and excellent member satisfaction. These standouts are recognized by Medicare with a 5-star rating — the highest possible score.
What many people don’t realize is that if a 5-star plan becomes available in your area, you don’t have to wait for the usual fall enrollment window to make a switch. Thanks to a special rule called the 5-Star Special Enrollment Period (SEP), you can join one of these top-rated plans almost any time of year.
Let’s take a closer look at what makes a 5-star plan special, how this special enrollment period works, and how you can decide whether switching to a 5-star plan is the right move for you.
Understanding Medicare’s Star Rating System
Every year, the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage and Part D prescription drug plans using a one-to-five-star system. These ratings give beneficiaries an easy way to compare plan quality, not just the benefits or cost.
A plan’s star rating is based on how well it serves its members in several key areas. Medicare evaluates things like customer service, preventive care, chronic condition management, member experience, and even how accurately a plan handles prescription drug pricing. Plans that consistently deliver excellent service and health outcomes receive higher ratings, while those with frequent complaints or poor performance fall lower on the scale.
In simple terms, a 5-star plan represents excellence. These plans perform better than their competitors in nearly every category, which is why Medicare allows beneficiaries a unique opportunity to switch into them even outside the typical enrollment seasons.
What Is the 5-Star Special Enrollment Period?
The 5-Star Special Enrollment Period is a special window of time that lets Medicare beneficiaries switch into a 5-star Medicare Advantage or Part D plan once per year. Normally, you can only change your coverage during the Annual Enrollment Period (October 15 to December 7) or during the Medicare Advantage Open Enrollment Period (January 1 to March 31). The 5-Star SEP provides a rare exception to that rule.
This enrollment period runs from December 8 through November 30 of the following year. That means you can use it almost any time, as long as there’s a 5-star plan available in your area. Once you enroll, your new coverage will start on the first day of the month after your enrollment request is submitted.
This flexibility can be a real advantage if your current plan isn’t meeting your needs. Instead of waiting months for the next open enrollment season, you can make a change right away and start enjoying better benefits and service sooner.
Who Can Use the 5-Star SEP?
The 5-Star Special Enrollment Period is open to any Medicare beneficiary who has both Part A and Part B and lives in an area where a 5-star plan is offered. You don’t have to currently be enrolled in a Medicare Advantage plan to qualify.
For example, if you have Original Medicare and decide you’d like to join a top-rated Medicare Advantage plan, you can use this SEP to do so. Or, if you’re already in a Medicare Advantage plan but aren’t happy with it, you can switch to a 5-star plan instead. The same rule applies to Part D prescription drug plans — if a 5-star drug plan becomes available, you can switch into it during this period.
However, there is one key rule: you can only use the 5-Star SEP once per year. That means you’ll want to take your time and make sure you’re choosing the right plan before you make the move.
How the 5-Star SEP Works
Using the 5-Star Special Enrollment Period is fairly straightforward. The first step is to find out whether any 5-star Medicare Advantage or Part D plans are available in your area. These plans aren’t offered everywhere, and availability can vary from year to year.
If a 5-star plan is available, it’s important to compare its coverage and network to your current plan. Even though it has a top rating, that doesn’t automatically mean it’s the best fit for your situation. You’ll want to review the monthly premium, out-of-pocket costs, provider network, prescription formulary, and any extra benefits the plan offers.
Once you decide to switch, you can enroll in the 5-star plan directly. When you do, Medicare will automatically disenroll you from your old plan. Your new coverage will begin the first day of the following month, and you’ll start receiving the new plan’s benefits at that time.
Why People Switch to 5-Star Plans
There are a few reasons why people take advantage of the 5-Star SEP. Often, it comes down to the quality and reliability that these plans provide.
Because 5-star plans consistently perform well in customer service and care coordination, members usually have fewer complaints and smoother experiences with billing, claims, and provider access. These plans often focus heavily on preventive care, wellness programs, and managing chronic conditions effectively.
For some, switching to a 5-star plan means gaining access to better customer service or more personalized care management. For others, it’s about peace of mind — knowing their plan is among the best in the country according to Medicare’s standards.
That said, a higher star rating doesn’t always mean higher costs or richer benefits. Some 5-star plans are competitively priced, while others might charge more for premiums or copays. The key is to look at the overall value, not just the rating itself.
Things to Consider Before You Switch
While the 5-Star SEP offers a valuable opportunity, it’s important not to rush into a decision. A plan’s star rating measures quality, but it doesn’t necessarily reflect whether that plan meets your individual healthcare needs.
Before making a switch, take a close look at the plan’s provider network to make sure your doctors and specialists are included. Review the prescription drug list, known as the formulary, to ensure your medications are covered and affordable. Check the premiums, copay amounts, and annual out-of-pocket limits to confirm the plan fits your budget.
Also consider any extra benefits the plan offers, such as dental, vision, or hearing coverage. These can add significant value — but only if they’re services you actually use.
Finally, remember that you can only use the 5-Star SEP once per year. If you make a change and later decide it’s not the right fit, you’ll have to wait until the next regular enrollment period to switch again. That’s why it’s smart to compare all your options carefully before making a final choice.
Find 5-Star Medicare Advantage Plans Near You
Understanding Medicare’s enrollment periods and star ratings can be overwhelming, especially when you’re trying to decide whether switching plans will actually benefit you. That’s where our team at Carolina Senior Benefits can make things simple.
We’ll help you find out whether a 5-star plan is available in your area and explain how it compares to your current coverage. Our licensed agents can review benefits, provider networks, and costs with you side by side, so you can see the full picture before you decide.
We take an educational, no-pressure approach — our goal is to help you make the best decision for your health and your wallet. If a 5-star plan makes sense for you, we’ll guide you through the enrollment process step by step and ensure your new coverage starts smoothly.
