SOURCE: Allsup


December 07, 2011 14:16 ET

New Medicare Five-Star Special Enrollment Allows for Year-Round Changes, but Options Limited, Allsup Finds

Allsup Explains New Enrollment Period Starting Tomorrow; Other Enrollment Options After Annual Open Enrollment Ends

BELLEVILLE, IL--(Marketwire - Dec 7, 2011) - Although Medicare annual enrollment ends today for most, a new year-round special enrollment period starts Dec. 8 for people interested in enrolling in five-star Medicare Advantage or prescription drug (Medicare Part D) plans. However, options are limited as few five-star plans are available, based on an analysis by Allsup, a nationwide provider of Medicare plan selection and Social Security Disability Insurance (SSDI) representation services.

"The five-star special enrollment period is designed to help people improve their coverage, encourage quality improvements and reward plans that Medicare reports as doing a good job," said Adrienne Muralidharan, senior Medicare specialist for the Allsup Medicare Advisor®. The Allsup Medicare Advisor is an impartial Medicare plan selection service that helps people understand and choose the most affordable and appropriate Medicare coverage for their healthcare needs. (Allsup does not accept fees or commissions from insurance providers and is not a Medicare plan provider.)

Starting Dec. 8, those enrolled in a plan that has 4.5 stars or fewer can switch to a Medicare Advantage plan or prescription drug plan in their area with a five-star rating. Medicare plans can have a rating from one (low) to five (high) stars. Individuals can only switch plans once a year using the five-star special enrollment period.

However, as of Nov. 30, there were only eight five-star Medicare Advantage contracts, covering 14 plans, available in a total of 10 states, with one available in each of the following seven states: California, Colorado, Hawaii, Illinois, Maine, Massachusetts and Oregon; two five-star plans available in both Iowa and Washington; and three five-star plans available in Wisconsin. Additionally, each of the following eight states has one five-star prescription drug plan available: Iowa, Minnesota, Montana, Nebraska, New York, North Dakota, South Dakota and Wyoming.

"Initially, most people will not have access to a five-star Medicare plan. Those who do need to be careful when deciding to change their plan based on a single rating," Muralidharan said. "Physician participation, prescription drugs covered and cost are among other factors that can be just as important to consider."

Specifically, Muralidharan noted, those considering changing to a five-star plan should:

  • Understand the rating system. The five-star rating is based on information Medicare gathers from member satisfaction surveys, the plans and healthcare providers based on the previous year's performance. So a plan that performed well in 2011 may not necessarily provide the same quality coverage in 2012. Also, the rating system does not rate new plans that may be available. "The rating also does not tell you if the plan is a better fit to your specific needs than the current plan you're using," Muralidharan said.

  • Understand the effects of changing plans. Under the five-star option, individuals can drop prescription drug coverage by changing from a Medicare Advantage plan with drug coverage to a Medicare Advantage plan without it. However, they would then have to wait until the next annual enrollment period (Oct. 15 - Dec. 7) to enroll in prescription drug coverage for the following year, and they may face a late-enrollment penalty.

Additional Enrollment and Switching Options During the Year

Other special circumstances allow individuals to join or change plans, as outlined below. A chart on Medicare special enrollment periods can be found at

  • Disenrollment period: From Jan. 1-Feb. 14, individuals can leave a Medicare Advantage plan and enroll in traditional Medicare. If they had Part D coverage under their Medicare Advantage plan, they can enroll in a prescription drug plan; but they can't add drug coverage if they previously did not have it.
  • Disability: Individuals who are determined by the Social Security Administration to be disabled become eligible for Medicare 24 months after they begin receiving cash SSDI benefits. They can join three months before to three months after this. Some exceptions exist for specific health conditions.
  • Turning 65: Seniors become eligible for Medicare at age 65, and they can enroll in their selected plan three months before, the month of and three months after their 65th birthday.
  • Loss of group health coverage: Individuals eligible for Medicare who have employer coverage have eight months following the month their employer coverage or employment ends (whichever is first) to enroll in Medicare.
  • Moving out of the plan's service area: People moving permanently out of their plan's service area are allowed to switch plans at any time during the year.
  • Nursing home residents: Someone who moves into, lives in or is leaving a nursing home can enroll in a new plan anytime during the year.
  • Fraud: Individuals who learn they were enrolled in a plan without their knowledge can contact their state health insurance program (SHIP) anytime to receive help with changing their plan.
  • Low income: Recipients receiving "extra help" can switch plans as needed to ensure they are getting the most cost-effective, appropriate coverage possible. This includes individuals eligible for Low-Income Subsidy (LIS), both Medicare and Medicaid at the same time (dual-eligible) or Supplemental Security Income (SSI) benefits.

For an evaluation of Medicare options, call an Allsup Medicare Advisor specialist at (866) 521-7655 or go to

Allsup is a nationwide provider of Social Security disability, Medicare and Medicare Secondary Payer compliance services for individuals, employers and insurance carriers. Founded in 1984, Allsup employs nearly 800 professionals who deliver specialized services supporting people with disabilities and seniors so they may lead lives that are as financially secure and as healthy as possible. The company is based in Belleville, Ill., near St. Louis. For more information, go to

The information provided is not intended as a substitute for legal or other professional services. Legal or other expert assistance should be sought before making any decision that may affect your situation.

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