A 68-year-old on a Part D plan opens her April explanation of benefits and sees the copay on her maintenance drug has jumped. The Annual Enrollment Period closed in December. The Medicare Advantage Open Enrollment Period, which she could not use anyway because she is on Original Medicare, closed on March 31. She assumes she is locked in until fall. She may not be.
Medicare rates every Medicare Advantage and standalone Part D plan on a 1-to-5-star quality scale, and the top of that scale unlocks a rarely discussed escape hatch: the 5-star Special Enrollment Period. If a 5-star-rated Medicare Advantage plan or Part D plan operates in your service area, you can switch into it outside the normal enrollment windows. This is a real, CMS-sanctioned SEP, and most people who could use it do not know it exists.
How the 5-Star SEP Actually Works
Star ratings measure customer service, member experience, complaint rates, and clinical quality. CMS updates the ratings every fall for the upcoming plan year. A plan carrying a 5-star badge for the 2026 plan year earned it in the October release; last year’s 5-star plans are not automatically this year’s.
The mechanics are narrow but useful:
- You can use the 5-star SEP once per calendar year.
- You can only switch into a 5-star plan, not out of one to something else. The destination has to carry the rating.
- A 5-star plan has to actually be available in your ZIP code’s service area. Availability varies sharply by county, and most counties do not have one.
- The SEP runs from December 8 through November 30 of the following year. Coverage generally begins the first of the month after you enroll.
Do not confuse this with the two windows most enrollees already know. The Annual Enrollment Period, October 15 to December 7, lets anyone change Medicare Advantage or Part D plans for a January 1 start. The Medicare Advantage Open Enrollment Period, January 1 to March 31, lets people already enrolled in Medicare Advantage make one switch, to another MA plan or back to Original Medicare. The 5-star SEP is a separate mechanism, tied to plan quality rather than the calendar.
How to Check Whether a 5-Star Plan Is Near You
Go to Medicare.gov and open the Medicare Plan Finder. Enter your ZIP code and the type of plan you want to compare (Medicare Advantage or Part D). Filter by star rating and set the floor at 5. If nothing shows up, the SEP is not available to you this year, no matter what a broker suggests. If a plan appears, click through and confirm the star rating is for the current plan year, because the tool sometimes shows summary ratings from prior years alongside the current one.
One trap deserves a plain warning. If you use the 5-star SEP to jump from Original Medicare (with a Medigap policy) into a Medicare Advantage plan, dropping the supplement is easy. Getting a Medigap plan back later usually means medical underwriting outside your one-time 6-month Medigap open enrollment window, and insurers in most states can deny you or charge more based on health. Do not treat the switch as reversible.
Why This Matters in a 2.8% COLA Year
The 2.8% Social Security COLA for 2026 did not keep pace with the $17.90 increase in the standard Part B premium, which rose to $202.90 from $185.00, or with the Part A inpatient deductible climbing to $1,736. A plan whose customer service and formulary genuinely work is worth more this year, because there is less slack in the retirement budget to absorb billing errors, prior-authorization delays, or a drug that moved to a higher tier without warning.
What to Do
- Open the Medicare Plan Finder on Medicare.gov, enter your ZIP code, and filter Medicare Advantage and Part D plans by 5-star rating for the current plan year. If one exists in your area and the formulary covers your drugs and doctors, you can move now.
- Before switching from Original Medicare plus Medigap into a 5-star Advantage plan, call your Medigap insurer and ask what it would take to get the supplement back. In most states, the answer is medical underwriting. Decide with that in view.
- Mark your calendar for the October CMS star ratings release. If your current plan drops below 5 stars, you do not lose coverage, but your 5-star SEP now points to different plans, and you get one use of it per calendar year.
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