Understanding the Medicare 5-Star Special Enrollment Period
The Medicare 5-Star Special Enrollment Period (SEP) is a Medicare enrollment window that allows eligible beneficiaries to switch to a Medicare Advantage or Medicare Part D prescription drug plan with a 5-star quality rating once per plan year. This SEP is designed to help beneficiaries transition to plans the Medicare program has identified as providing the highest level of quality performance and member satisfaction.
The Medicare 5-Star SEP is available annually from December 8 through November 30 of the following year. During this time, eligible beneficiaries can make a one-time change to enroll in a qualifying 5-star plan if one is available in their area.
When can I change Medicare plans using this SEP?
The 5-Star Special Enrollment Period is unique because it offers flexibility beyond the standard . However, there are specific rules regarding the frequency and timing of these changes:
Frequency: You can use the 5-Star SEP only once per plan year.
Effective Date: Once you submit your enrollment request, your new coverage will begin on the first day of the month following the month the plan receives your request.
Availability: You must live in an area where a 5-star rated plan is currently offered. If no plans in your service area have earned the 5-star rating for the current year, you cannot use this SEP.
How to Change Your Medicare Part D Plan Mid-Year
The 5-Star SEP offers a way to switch to a higher-rated option without waiting for the Annual Enrollment Period.
Beneficiaries looking to update their coverage can use this SEP to:
Switch from a standalone PDP to a 5-star rated Medicare Advantage plan with drug coverage (MAPD), provided you are already enrolled in both Medicare Part A and Part B.
How the Medicare 5-Star Rating System Works
The Centers for Medicare & Medicaid Services (CMS) uses a Medicare Star Ratings system to measure the quality of health and drug plans. Ratings range from 1 to 5 stars, with 5 stars representing excellent performance. CMS evaluates plans based on several factual criteria, including:
Customer Service: How well the plan handles member appeals and provides assistance.
Member Complaints: How often members report problems or choose to leave the plan.
Chronic Condition Management: The plan’s effectiveness in ensuring members with long-term illnesses get recommended tests and treatments.
Preventative Care: How well the plan encourages screenings, vaccines, and annual checkups to keep members healthy.
Check Medicare Plan Ratings in Your Area
It is important to remember that 5-star plans are not available in every ZIP code. Furthermore, CMS recalculates plan ratings every year. Before attempting to use this Special Enrollment Period, you must verify the current rating for specific plans in your area, as a plan’s performance can fluctuate annually.
Does plan rating affect Medicare plan premiums?
Not directly. A 5-star rating reflects quality and member satisfaction, not necessarily the plan's cost. While highly rated plans often receive government financial bonuses that they may use to offer additional benefits, they may still have varying monthly premiums, deductibles, and copays. You should always compare the plan's total cost with its star rating to ensure it fits your financial needs.
5-Star Medicare Advantage Plans 2027: What to Expect
CMS typically releases the updated Star Ratings for the upcoming year each fall. If you are looking at Medicare Advantage plans for 2027, you must check the new list released in late 2026. A plan that holds a 5-star rating in 2026 is not guaranteed to retain that "Excellent" status for 2027. If a plan’s rating drops to 4.5 stars or lower, you will no longer be able to use the 5-Star SEP to join it.
Medicare Advantage Maximum Out-of-Pocket 2026
While a plan’s quality rating is important, so is prioritizing financial protection. Every Medicare Advantage plan has a maximum out-of-pocket (MOOP) limit. This is the most you will have to pay for covered medical services in a single year.
As you evaluate 5-star plans for 2026, it’s beneficial to review the plans’ MOOP. Even the highest-rated plans have different limits, and ensuring the MOOP aligns with your personal healthcare budget can help you when budgeting for annual healthcare costs.
How to Find a 5-Star Medicare Plan and Enroll
While Medicare publishes Star Ratings through CMS, plan availability varies by ZIP code, and not every area offers a 5-star Medicare Advantage or Part D plan each year.
In addition to checking local availability, beneficiaries also need to compare:
Monthly premiums
Provider and pharmacy networks
Prescription drug formularies
Out-of-pocket costs
Additional benefits and coverage rules
Because these details can change annually, reviewing Medicare plan options on your own may feel overwhelming or confusing. If you qualify for a Medicare 5-Star SEP, one option is to explore available plans with the help of a licensed insurance agent who understands Medicare enrollment rules. SelectQuote’s licensed insurance agents can help beneficiaries:
Check whether a 5-star plan is available in their ZIP code
Review available plans against their current coverage
Review prescription drug and provider network compatibility
Explain costs, benefits, and enrollment timelines
Navigate the Medicare plan enrollment process
This guidance can help you determine whether enrolling in a 5-star Medicare plan makes sense for your healthcare needs and budget. Let us help you through your Medicare plan journey, ensuring you feel confident in your Medicare plan coverage.
SelectQuote Senior Insurance Services is a division of SelectQuote Insurance Services. © 2025 SelectQuote Senior Insurance Services. All rights reserved.
We do not offer every plan available in your area. Currently, we represent 16 organizations which offer 99,387 products in your area. Please contact Medicare.gov, 1–800–MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
SelectQuote represents Medicare Advantage [HMO, PPO, PFFS] organizations and/or Medicare-approved Part D sponsors that have a Medicare contract. Enrollment depends on the plan’s contract renewal.
Enrollment in the described plan type may be limited to certain times of the year unless you qualify for a Special Enrollment Period.
Enrollment during the Medicare Advantage Open Enrollment Period (OEP) is limited to January 1 - March 31. Medicare beneficiaries enrolled in a Medicare Advantage Plan are eligible to participate in OEP. If you are aging into Medicare, have recently moved, or lost coverage, you may be eligible for a Special Enrollment Period.
A 5-star Special Enrollment Period may be used one time between December 8 and November 30, provided you meet the plan's enrollment requirement.
Please see the Disclosures Page for more information.
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