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.
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:
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:
Star Ratings should be used alongside the plan’s current benefits, network, formulary, service area, and the client’s individual needs.
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:
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.
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:
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.
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:
The beneficiary must meet all other enrollment requirements, including living in the plan’s service area.
No. A beneficiary may generally use the 5-star SEP only once during the applicable December 8 through November 30 period.
It is not:
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.
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:
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.
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:
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.
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:
That coordinating SEP does not apply to every MA-only plan.
Before using the 5-star SEP, agents should document:
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:
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.
Consider two hypothetical Medicare Advantage Prescription Drug plans available in the same county:
| Feature | Plan A | Plan B |
|---|---|---|
| Overall Star Rating | 5 stars | 4 stars |
| Monthly premium | $35 | $0 |
| Primary care physician | In network | In network |
| Preferred specialist | Out of network | In network |
| Preferred hospital | In network | In network |
| Key prescription | Nonformulary | Tier 2 |
| Specialist copay | $45 | $30 |
| In-network maximum out of pocket | $7,500 | $5,500 |
| Dental benefit | Higher allowance | Lower allowance |
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.
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.
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.
Check whether the client meets any applicable requirements involving:
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.
Write down the change:
Current coverage → destination coverage
Then determine whether the transaction affects:
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.
Record:
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:
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.
The SEP is available from December 8 through November 30 and may generally be used once during that period.
The plan must have an overall rating of five stars for the applicable year.
Availability is county- and service-area-specific.
Moving to an MA-only plan or standalone PDP can change or eliminate the client’s existing medical or drug coverage.
Providers, prescriptions, costs, networks, and plan rules still determine suitability.
Star Ratings can change annually. Confirm the current rating and plan year.
A five-star rating measures quality and performance. It does not guarantee a particular benefit package or lower member expenses.
A client who uses the SEP may not be able to use it again during the same applicable period.
Keep records showing the destination plan’s rating, service-area eligibility, coverage comparison, and client decision.
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:
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.
Before using the 5-star SEP, ask:
These questions help prevent a quality rating from replacing a full needs assessment.
After a 5-star SEP enrollment, follow up to confirm:
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.
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:
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.
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.
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.
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.
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.
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.