5-Star Medicare Advantage Plans: What Agents Need to Know

A 5-star Medicare Advantage plan has earned the highest overall quality rating assigned through the Centers for Medicare & Medicaid Services Star Ratings program.

When a 5-star Medicare Advantage, Medicare Cost, or standalone Medicare Part D plan is available in a beneficiary’s service area, the beneficiary may be able to use the 5-star Special Enrollment Period to enroll outside the Medicare Annual Enrollment Period.

However, the 5-star SEP is not an unlimited year-round switching opportunity.

A beneficiary may generally use it one time between December 8 of the year before the plan year and November 30 of the plan year. The beneficiary must also live in the plan’s service area and meet all applicable enrollment requirements.

Agents should evaluate the plan’s complete fit before recommending a change. A 5-star rating is valuable quality information, but it does not replace a review of providers, prescriptions, premiums, medical cost sharing, prior authorization, supplemental benefits, and maximum out-of-pocket exposure.

What Is a 5-Star Medicare Advantage Plan?

Medicare Advantage plans are private health plans that contract with Medicare to provide Medicare Part A and Part B benefits. Many also include Medicare Part D prescription drug coverage.

Each year, CMS rates eligible Medicare Advantage and Part D contracts on a scale from one to five stars:

• 5 stars: Excellent performance.
• 4 stars: Above-average performance.
• 3 stars: Average performance.
• 2 stars: Below-average performance.
• 1 star: Poor performance.

A plan with a 5-star overall rating has earned CMS’s highest quality designation for that contract year.

The rating does not mean that the plan:

• Has the lowest premium.
• Covers every prescription.
• Includes every provider.
• Offers the largest supplemental benefits.
• Has no prior authorization requirements.
• Produces the lowest out-of-pocket costs for every member.
• Is the best choice for every beneficiary.

Star Ratings should be used alongside the plan’s current benefits, network, formulary, service area, and the client’s individual needs.

What Does CMS Measure in Medicare Star Ratings?

CMS publishes Medicare Advantage and Part D Star Ratings annually using quality and performance measures collected from plans, health care providers, member surveys, complaints, and administrative data.

For 2026, CMS rates Medicare Advantage Prescription Drug contracts on up to 43 measures, Medicare Advantage-only contracts on up to 33 measures, and standalone Part D contracts on up to 12 measures.

The measures can address areas such as:

• Preventive care and screenings.
• Management of chronic conditions.
• Member experience.
• Access to care.
• Complaints.
• Customer service.
• Medication adherence.
• Drug safety.
• Accuracy of drug pricing.
• Appeals and plan performance.

CMS groups individual measure scores into broader categories and calculates summary and overall ratings.

The methodology can change from year to year. Measure weights, cut points, specifications, and adjustment policies may change, which means a contract’s rating can move even when its underlying performance does not change dramatically.

PSM’s article about why Medicare Advantage Star Ratings fell for 2026 explains why agents should not assume that every ratings decrease represents a sudden decline in plan quality.

When Are Medicare Star Ratings Released?

CMS generally publishes updated Medicare Advantage and Part D Star Ratings each fall for the upcoming contract year.

The ratings appear on Medicare Plan Finder and can be used by beneficiaries comparing coverage during the Medicare Annual Enrollment Period.

The rating attached to a plan can change from one year to the next. Agents should therefore verify the rating for the applicable contract year rather than relying on:

• An old brochure.
• A prior-year presentation.
• A saved Medicare Plan Finder screenshot.
• A carrier’s historical reputation.
• An outdated quoting-platform result.
• A marketing piece created for an earlier plan year.

The 2026 Star Ratings were published on Medicare Plan Finder on October 9, 2025. CMS reported that approximately 40% of Medicare Advantage Prescription Drug contracts offered in 2026 earned at least four stars. The ratings used for consumer comparison can also influence future Medicare Advantage quality bonus payments.

What Is the 5-Star Special Enrollment Period?

The 5-star Special Enrollment Period allows an eligible beneficiary to enroll in a Medicare plan with an overall performance rating of five stars outside the usual Annual Enrollment Period.

The beneficiary may generally use this SEP one time from December 8 through November 30.

For example, a plan that has a 5-star overall rating for 2026 can generally accept qualifying 5-star SEP enrollment requests from December 8, 2025, through November 30, 2026.

The effective date is generally the first day of the month after the plan receives the completed enrollment request.

The SEP may be used to enroll in an available:

• 5-star Medicare Advantage-only plan.
• 5-star Medicare Advantage Prescription Drug plan.
• 5-star standalone Medicare Prescription Drug Plan.
• 5-star Medicare Cost Plan.

The beneficiary must meet all other enrollment requirements, including living in the plan’s service area.

Can a Beneficiary Use the 5-Star SEP More Than Once?

No. A beneficiary may generally use the 5-star SEP only once during the applicable December 8 through November 30 period.

It is not:

• A monthly Medicare Advantage SEP.
• A quarterly SEP.
• An unlimited opportunity to switch among 5-star plans.
• A second Annual Enrollment Period.
• A general SEP for dissatisfied beneficiaries.
• Permission to enroll in any plan with a rating higher than the current plan.

The destination plan must have an overall rating of five stars for the applicable year.

A beneficiary already enrolled in a 5-star plan may use the SEP to move to another available 5-star plan, but the once-per-period limitation still applies.

Can Someone Enroll in a 5-Star Plan From Original Medicare?

Yes. An eligible beneficiary may generally use the 5-star SEP to enroll in a 5-star Medicare Advantage-only or Medicare Advantage Prescription Drug plan while coming from Original Medicare.

Before recommending the change, the agent should review:

• Whether the client has a Medigap policy.
• Whether the client may have a trial right or guaranteed-issue right.
• Whether the Medigap policy can be recovered later.
• Prescription coverage.
• Provider access.
• Plan-network rules.
• Prior authorization.
• Medical cost sharing.
• Maximum out-of-pocket exposure.

Entering Medicare Advantage can affect existing Medigap coverage and future Medigap options. Agents should not recommend canceling a Medigap policy until the client understands the consequences and the new coverage has been properly confirmed.

What Happens When Someone Moves to a 5-Star Standalone Part D Plan?

A beneficiary enrolled in Medicare Advantage who uses the 5-star SEP to enroll only in a 5-star standalone Prescription Drug Plan will generally be disenrolled from Medicare Advantage and returned to Original Medicare for medical coverage.

That change can materially affect:

• Provider coverage.
• Hospital and medical cost sharing.
• Supplemental benefits.
• Maximum out-of-pocket protection.
• Dental, vision, and hearing benefits.
• Transportation.
• Allowances.
• Care coordination.
• Medigap eligibility.

The client should understand that enrolling in a standalone PDP is not merely a drug-plan change when the client currently has Medicare Advantage coverage.

Could a Client Lose Prescription Drug Coverage?

Yes.

A client could lose prescription drug coverage by moving from an MA-PD plan to certain 5-star Medicare Advantage-only plans.

For example, enrolling in a 5-star MA-only coordinated care plan may cause the client to lose Part D coverage without creating an immediate right to enroll in a standalone PDP. The client could then have to wait for another valid enrollment period and may eventually face a Part D late-enrollment penalty.

A coordinating Part D SEP is available in limited situations when a beneficiary uses the 5-star SEP to enroll in:

• A 5-star Medicare Advantage Private Fee-for-Service plan without drug coverage.
• A qualifying 5-star Medicare Cost Plan.

That coordinating SEP does not apply to every MA-only plan.

Before using the 5-star SEP, agents should document:

• The client’s current drug coverage.
• Whether the destination plan includes Part D.
• Whether the destination plan permits concurrent PDP enrollment.
• Whether a coordinating Part D SEP applies.
• The expected effective dates.
• Potential late-enrollment-penalty exposure.

Does a 5-Star Rating Mean a Client Should Switch?

No.

A 5-star rating is one useful comparison point, but a higher-rated plan may still be unsuitable for a particular client.

Before recommending a change, compare:

• Primary care physicians.
• Specialists.
• Hospitals.
• Pharmacies.
• Prescription formularies.
• Drug tiers.
• Prior authorization.
• Step therapy.
• Monthly premiums.
• Medical copays and coinsurance.
• Inpatient hospital costs.
• Maximum out-of-pocket limits.
• Dental, vision, and hearing benefits.
• Transportation.
• Allowance restrictions.
• Referral requirements.
• Out-of-network coverage.
• Travel needs.
• Chronic-condition needs.

A 4-star plan that covers the client’s doctors and prescriptions may be more appropriate than a 5-star plan that does not.

Likewise, a lower rating does not automatically mean that the client’s current plan has become unsafe or unsuitable.

5-Star Plan Comparison Example

Consider two hypothetical Medicare Advantage Prescription Drug plans available in the same county:

Plan A has the higher Star Rating and dental allowance. Plan B may nevertheless fit the client better because it includes the preferred specialist, covers the client’s prescription, and has lower potential medical costs.

The rating informs the comparison. It does not decide it.

How Agents Should Verify a 5-Star SEP

Step 1: Confirm the Destination Plan’s Overall Rating

Use current Medicare Plan Finder information, carrier materials, and approved quoting or enrollment tools.

Confirm that the plan has an overall five-star rating for the relevant plan year. A five-star score on one individual measure does not make the plan eligible for the 5-star SEP.

Step 2: Confirm the Service Area

Verify that the beneficiary permanently resides in the plan’s approved service area.

A carrier may have 5-star plans in selected counties but not throughout the state.

Step 3: Confirm Plan Eligibility

Check whether the client meets any applicable requirements involving:

• Medicare Part A and Part B.
• Service-area residence.
• Special Needs Plan eligibility.
• Medicaid status.
• Chronic-condition eligibility.
• Institutional status.
• Other plan-specific requirements.

Step 4: Confirm the SEP Has Not Already Been Used

The beneficiary may use the 5-star SEP once during the applicable period.

Ask whether the client has already made a plan change using the SEP and verify through approved systems when possible.

Step 5: Review the Coverage Transition

Write down the change:

Current coverage → destination coverage

Then determine whether the transaction affects:

• Medicare Advantage coverage.
• Original Medicare enrollment.
• Part D coverage.
• Medigap coverage.
• Provider access.
• Supplemental benefits.
• The client’s maximum out-of-pocket protection.

Step 6: Explain the Effective Date

Coverage is generally effective on the first day of the month after the plan receives the completed enrollment request.

Do not promise an effective date before the application and SEP qualification have been accepted.

Step 7: Document the Recommendation

Record:

• The current plan.
• The destination plan.
• The five-star rating source.
• SEP eligibility.
• Service-area verification.
• Provider checks.
• Prescription review.
• Cost comparison.
• Coverage-transition explanation.
• Client decision.
• Expected effective date.

Can Agents Market the 5-Star SEP?

Agents may educate beneficiaries about the availability of 5-star plans and the associated SEP, subject to current CMS, carrier, third-party marketing organization, consent, and marketing-material requirements.

Marketing should not imply that:

• Every county has a 5-star plan.
• Every beneficiary qualifies.
• The plan can be joined an unlimited number of times.
• The plan is “the best” because it has five stars.
• A 5-star plan necessarily costs less.
• The client will receive better benefits.
• The client’s current coverage is poor.
• CMS recommends that the client switch.
• The beneficiary can enroll without a complete needs assessment.

Use current carrier-approved materials and verify that the advertised plan is available in the targeted service area.

PSM’s guide to navigating Medicare marketing rules provides additional guidance for agent outreach and plan communications.

Common 5-Star SEP Mistakes

Calling It Year-Round Open Enrollment

The SEP is available from December 8 through November 30 and may generally be used once during that period.

Enrolling a Client in a Plan With One Five-Star Measure

The plan must have an overall rating of five stars for the applicable year.

Assuming Every Market Has a 5-Star Plan

Availability is county- and service-area-specific.

Ignoring Prescription Coverage

Moving to an MA-only plan or standalone PDP can change or eliminate the client’s existing medical or drug coverage.

Recommending the Plan Based Only on Its Rating

Providers, prescriptions, costs, networks, and plan rules still determine suitability.

Using a Prior-Year Rating

Star Ratings can change annually. Confirm the current rating and plan year.

Promising Better Benefits or Lower Costs

A five-star rating measures quality and performance. It does not guarantee a particular benefit package or lower member expenses.

Forgetting That the SEP Can Be Used Only Once

A client who uses the SEP may not be able to use it again during the same applicable period.

Failing to Document Eligibility

Keep records showing the destination plan’s rating, service-area eligibility, coverage comparison, and client decision.

How Star Ratings Affect Plans and Agents

Star Ratings affect more than consumer comparisons.

Plans earning at least four stars may qualify for Medicare Advantage Quality Bonus Program payments. Those payments can influence plan finances and may support supplemental benefits, lower cost sharing, premium reductions, or other plan investments.

However:

• A bonus does not guarantee a specific benefit.
• A ratings decline does not prove that benefits will be reduced.
• A plan can change benefits for reasons unrelated to its rating.
• A lower-rated plan may still meet a client’s needs.
• A higher-rated plan may not be available in the client’s county.

For the 2026 ratings, CMS changed measure weights and added or restored certain measures. As a result, agents should avoid comparing ratings across years without considering methodology changes.

PSM’s 2026 Medicare Advantage Star Ratings overview provides additional market context.

A Six-Question Client Conversation

Before using the 5-star SEP, ask:

1. Why is the client considering a change?
   Identify the actual provider, prescription, service, cost, or coverage concern.
2. Does the destination plan include the client’s providers?
   Verify important doctors, specialists, facilities, and pharmacies.
3. How does the plan cover the client’s prescriptions?
   Review the formulary, tiers, pharmacies, and utilization requirements.
4. What coverage will the client leave behind?
   Explain the loss of Medicare Advantage, Part D, Medigap, or supplemental benefits when applicable.
5. What could the client pay during the year?
   Compare premiums, routine copays, hospital costs, and maximum out-of-pocket exposure.
6. Has the client already used the 5-star SEP?
   Confirm that the one-time election remains available.

These questions help prevent a quality rating from replacing a full needs assessment.

Post-Enrollment Follow-Up

After a 5-star SEP enrollment, follow up to confirm:

• The application was accepted.
• The effective date.
• Disenrollment from the prior plan.
• Part D coverage.
• Identification-card delivery.
• Provider access.
• Pharmacy access.
• Supplemental-benefit activation.
• Any Medigap-related action.
• Client understanding of the new plan.

Document the follow-up in the agency’s customer relationship management system.

PSM’s Medicare agent resources can help agents manage plan comparisons, enrollments, marketing, and year-round client service.

The Bottom Line for Medicare Agents

A 5-star Medicare Advantage plan has earned CMS’s highest overall quality rating, and its availability may create a valuable Special Enrollment Period.

But the SEP has important limits:

• It may generally be used once.
• It runs from December 8 through November 30.
• The destination must be an eligible plan with an overall five-star rating.
• The beneficiary must meet the plan’s enrollment requirements.
• The change can affect Medicare Advantage, Part D, Medigap, providers, benefits, and out-of-pocket exposure.

A 5-star rating can strengthen a plan comparison. It should never replace one.

Agents should confirm the rating, verify eligibility, compare the complete coverage package, explain the transition, and document why the destination plan fits the client.

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Explore PSM’s Medicare solutions or get contracted with PSM Brokerage to learn more.

External Sources

1. Centers for Medicare & Medicaid Services: 2026 Medicare Advantage and Part D Star Ratings Explains the 2026 Medicare Advantage and Part D Star Ratings methodology, measure counts, methodology changes, and contract-rating distribution.

2. Centers for Medicare & Medicaid Services: 2026 Medicare Advantage and Part D Enrollment and Disenrollment Guidance Provides the official 5-star SEP requirements, permitted enrollment changes, effective-date rules, and warnings about losing Medicare Advantage or Part D coverage.

3. Centers for Medicare & Medicaid Services: Part C and Part D Performance Data Provides current Star Ratings fact sheets, technical notes, measure specifications, and downloadable performance data.

4. Medicare.gov: Special Enrollment Periods Provides consumer-facing information about Special Enrollment Periods, including the opportunity to join an available plan with an overall five-star rating.

5. Medicare.gov: Find Health and Drug Plans Allows beneficiaries and agents to review current plan availability, costs, benefits, formularies, and Star Ratings by location.

For licensed insurance agent education only. This article is not legal or compliance advice and does not replace current CMS, Medicare, carrier, plan, state, or enrollment-platform guidance. Star Ratings, plan availability, benefits, provider networks, formularies, eligibility requirements, election periods, and effective dates may change. Verify current plan-specific information before marketing or submitting an enrollment.