How To Avoid This Mistake With 5-Star Medicare Advantage Plans

Updated: September 28, 2020 at 7:59 pm

introduce mistakes you can make when enrolling in 5-star medicare advantage plansThere are 5-star restaurants. Five-star generals, too. You hear service organizations promote “five-star service”. There are even 5-star medicare advantage plans.

What does 5-star mean to you? Right…the best.

Do you want to enroll in a 5-star Medicare Advantage plan?

Of course, you say!

Well, it’s not as easy as it sounds. There’s a lot to consider.

Moreover, you can make mistakes that can take months – and a lot of money – to fix.

In this article, we will discuss how to avoid #1 mistake people make in a 5-star medicare advantage plans. (Related: check out the 5 mistakes Medicare beneficiaries make when selecting a plan.)

Here’s what we will discuss:

Let’s dive in and discuss what star ratings are.


What Are Star Ratings?

The Medicare star ratings a way to measure a Medicare beneficiary’s experience with Medicare Advantage and Prescription Drug Plans.

The Centers for Medicare and Medicaid (CMS) releases the star ratings every year, usually towards the end of October to early November.

The ratings are available to the public and help guide beneficiaries into making a decision about Medicare Advantage and/or prescription drug plans. (Note: CMS does not rate Medicare supplement plans.)

CMS rates the Medicare Advantage plans on 45 different performance including:

  • Care coordination
  • Timeframe of appeals decisions
  • Adult BMI Assessments

PDP plans are a bit different. CMS rates PDPs on 14 performance measures including:

  • Price Accuracy
  • Availability of an interpreter or TTY
  • Medication adherence for people with Diabetes

The stars range from one star to five stars. Of course, the higher the stars, the better, generally speaking.

Five-star plans are the highest issued by CMS. As you can imagine, it is hard for plans to consistently attain and maintain 5-stars.

Special Election Period For 5-Star Medicare Advantage Plans

CMS rewards those plans attaining 5-stars with a special election period. If you live in a county that contains a 5-star Medicare Advantage or Prescription Drug plan, you can disenroll from your current plan and enroll in the 5-star plan any time, with the exception of the time between December 1 and 7.

That is right. Any time (except for the blackout period). You don’t have to wait for AEP/OEP, MADP, or any other timeframe.

As we said earlier, not many plans attain 5 stars. In fact, in 2020, only 20 Medicare Advantage plans attained a 5-star rating. That’s only 5% of plans across the nation.

If you live in these states, you likely have access to a 5-star Medicare Advantage plan (subject to the county you live):

  • Massachusetts
  • Florida
  • Texas
  • Colorado
  • California
  • Georgia
  • Maine
  • New Hampshire
  • Minnesota
  • Maryland
  • Virginia

So, if you live in one of these states (and in one of the counties), how do you enroll?

Simple. You just fill out the application and mark the 5-star special election period on the application. The carrier then reviews your application.

If you are approved and accepted, then the new coverage begins on the first day of the following month.

OK, John. I am ready to apply, you say. Let’s do this!

Hold on here. As I mentioned before, you can make a major and expensive mistake. We discuss this next.


What Is The Mistake People Make With 5-Star Medicare Advantage Plans?

Let me first say that it has nothing to do with the plan itself.

If you check out the listing of current 5-Star Medicare plans, you will see a common theme.

The theme is that most, if not all of them, are HMO plans.

Do you know what an HMO plan is?

No?

It is managed care. In other words, and layman’s terms, you have to select a primary care physician (PCP). Your PCP is the “quarterback” for your care. He or she refers you to specialists within the network.

This means, you always have to go to a doctor, facility, or hospital within the to show mistake with 5-star medicare advantage plansnetwork.

Now, these are 5-star Medicare Advantage plans. So, they likely have good and robust networks. However, there is always the chance that your doctor or specialist does not accept the plan.

You might be doing yourself more financial damage by moving to a 5-star plan than just staying put.

Let’s say you really like your doctor and the specialists you see. You heard about the Tufts 5-star Medicare Advantage Plans in Massachusetts. You decide to enroll in one of the Tufts plans. A couple of months later, you go to your doctor. A few weeks after that, you receive a bill for the full amount of the doctor’s visit. You are disheartened to learn that your doctor or the specialists do not take Tufts.

However, you think you can just make the switch back to your other Medicare Advantage plan. Everything would then be good, right?

Wrong, likely you can’t. Unless you qualify for another SEP, you’d have to wait for the annual open enrollment period (AEP or OEP) with an effective date of 1/1 of the ensuing year.

Same Thing With Prescription Drug Coverage

A similar situation exists with prescrtiption drugs. You might switch to a 5 star plan, but is the plan covering your drugs?

For example, your drug might be a tier 2 with your current plan, but a tier 3 or 4 with another plan. If you make that switch, you’ve unnecessarily increased your cost.

There’s a way to mitigate all this, and we discuss this next.


How To Enroll In A 5-Star Medicare Advantage Plan The Right Way

So, there is an easy way to mitigate all of this and see if a 5-star Medicare Advantage plan is right for you.

What is it, John, you ask?

Simple. Do your homework.

You have to roll up your sleeves and spend an hour or two determining if the plan is right for you.

You have to make sure your doctors accept the insurance. Additionally, you need to review and see if your prescription drugs line up favorably.

If they don’t, moving to a 5-star Medicare Advantage plan does more harm than good. You’ll end up spending way more money than you have to. As we pointed out earlier, most 5-star Medicare Advantage plans are HMO plans. (Related: see how you can save money on your Medicare plans.)

If your situation fits, then a 5-star Medicare Advantage could be right for you.

If not, you have other options. We discuss those next.


Other Options Instead Of 5-Star Medicare Advantage Plans

Do you have to move to a 5-star plan?

No, you don’t.

There are many 4 and 4.5 star plans. They are solid plans.

And, likely, you might be enrolled in one of them.

Have you had any issues with them? Has the plan covered you well?

If so, then you might just want to stay. With health care, no need to fix what is not broken, right?

But, if you’ve had service issues with your plan or something like that, then looking into a new plan might be in your best interest.

Of course, do your due diligence. As we discussed, don’t move into a 5-star plan just because of the number of the stars.

You would then use the 5-star SEP to move into your new plan.

Do you have to contact your old plan? No, the change is processed and automatic.


Now You Know How To Avoid This Mistake With 5-Star Medicare Advantage Plans

Now you know how to avoid this large mistake with 5-star Medicare Advantage plans.

Avoid this mistake really revolves around your doctor networks and prescription drug needs.

Do you have questions or need assistance? We at My Family Life Insurance are happy to answer any questions.

Feel free to contact us or use the form below. Note that filling out the form below or through our contact page is an expressed permission to contact you. Don’t worry; we don’t call you a billion times a day or sell your information. That is a promise.

As I always say, at the very least, if we can’t help you, you’ll learn something new. We’ll part as friends, and that is the truth.

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John

I am a CFP® Professional and have an MBA. I founded My Family Life Insurance to provide honest, trustworthy advice and economical insurance solutions to individuals, families, and business owners. Contact me if you have any questions. There is no risk! If I can't help you, you've learned a little more, and we'll part as friends. Seriously! Can your current agent say this?

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