The Centers for Medicare and Medicaid (CMS), in an effort to move people from low performing Medicare Advantage plans, has
allowed a one time special enrollment period for people to switch plans. Medicare beneficiaries that are enrolled in a Medicare Advantage plan that has consistently earned a 3 star rating or less for the last 3 years can now switch to a higher rated plan outside of the Annual Enrollment or open period.
Medicare Advantage Star Rating
The Medicare Star rating compiles information from five different areas about the specific Medicare Advantage health plan:
- Keeping members healthy
- Managing chronic conditions
- Member experience
- Member complaints
- Customer service
Poor performers can be dropped
Medicare assigns a star rating from 1 to 5, with 5 being excellent, based on information from 37 different topics within the major categories from member satisfaction surveys. The star rating also determines how much Medicare reimburses the plan every month for each enrolled member.
Medicare encouraging good track records
Medicare Advantage plans that are consistently receiving 3 or fewer stars have issues that they are not resolving to the satisfaction of Center for Medicare and Medicaid and their members. Medicare wants to encourage Medicare beneficiaries to enroll in plans that have shown a good track record of making sure individuals get the health care they are eligible for with minimal complications.
Special Election Period (SEP)
If you, or someone you care for, received one of the “Consistent Poor Performer” notices, you have the opportunity to enroll in a higher star rated plan with no penalties. This is a one time Special Enrollment Period (SEP). You can have a Medicare Advantage certified insurance agent review different plans that have higher ratings, but you can’t enroll with the agent. You can only switch plans by calling Medicare at 1-800-MEDICARE (1-800-633-4227), reference CMS Product No. 11633 of 11633-S
Full CMS explanation and letter below
Introduction to the Consistent Poor Performer February Notice
What’s the purpose of this notice?
This notice lets people know that they recently enrolled in a plan that has been identified as a consistent poor performer. This means that the plan has received an overall star rating of less than three stars for at least three years.
This notice informs people of a one-time opportunity to move into a higher rated plan. .
Who gets this notice?
Medicare mails this notice to people who are enrolled in plans that have an overall star rating of “poor” or “below average” for at least the last three years. The February notice is specifically sent to people who enrolled in consistently poor performing plans during the Medicare fall open enrollment period.
This is the second of two notices being sent to individuals in low performing plans. The first notice was sent in October (CMS Product Number 11627) to beneficiaries enrolled in poor performing plans as of the beginning of the fall open enrollment period.
When do people get this notice?
This notice is mailed in February.
What should people do next?
People with Medicare should consider their options carefully. They should:
• Review their health and prescription drug needs and use the Medicare Plan Finder to find and compare plans in their area.
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
• Call their State Health Insurance Assistance Programs (SHIP) for free personalized health insurance counseling. See the “Medicare & You” handbook or call 1-800-MEDICARE for the phone number for their state.
People should reference CMS Product No. 11633 of 11633-S if they call Medicare or their SHIP with questions.
Important Information About Your Medicare Plan Options
Each year we give star ratings to Medicare health and drug plans. These ratings help you compare plans based on their quality and performance. A 5-star rating is considered “excellent.”
You recently enrolled in <organization’s name=””>’S . has been rated “poor” or “below average” for at least the last three years. If you decide you don’t want to be in this plan, you have a one-time chance to choose and enroll in a plan rated 3-stars or better.
What to Do Next
1. Visit www.medicare.gov/find-a-plan to find and compare plans in your area. You can even enter your information for a personalized search if you like. Once you see the list of plans, you can view the star ratings by selecting the plan name.
2. Review your health and prescription drug needs and compare your coverage with other available options to see if there’s a better choice for you.
If You Want to Change Plans
You can change plans by calling 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Your new coverage will start the first day of the month after you call.
Get Help & More Information
To get help with your choices, call your State Health Insurance Assistance Program (SHIP) at <SHIP phone number> or call 1-800-MEDICARE.