Medicare 5-Star Special Enrollment Period, Explained
What the Medicare 5-star Special Enrollment Period actually allows, the coverage risk it carries in each direction, and how to check whether a five-star plan serves a client's county for 2027.
The Medicare 5-star Special Enrollment Period is a rule that lets a person switch into a five-star Medicare plan. CMS has to rate the plan five stars overall for the coming year. The window runs December 8 through November 30 of the following year. It only opens where a five-star plan actually serves the client's county.
How the Medicare 5-Star Special Enrollment Period Works
CMS rates every Medicare Advantage and Part D contract from one to five stars each fall. The rating covers measures such as member experience, chronic-condition management, and complaint volume. A contract earns 5-star SEP eligibility the moment CMS assigns it a five-star overall rating for the coming contract year. That rule sits in 42 CFR 423.38(c)(20). A client may use this SEP only once per contract year. The switch takes effect the first day of the month after the plan receives the request.
How Many 5-Star Plans Are There for 2027?
Fifteen Medicare Advantage contracts earned an overall five-star rating for 2027. That is down from twenty-two for 2026, according to the CMS 2027 Star Ratings Fact Sheet, released October 8, 2026. No stand-alone Part D drug plan reached five stars for 2027. The SEP applies only to Medicare Advantage contracts, with or without drug coverage, in the counties those fifteen contracts serve.
Finding a five-star plan in one county takes more than the national count. The fact sheet reports contracts, not ZIP codes. A contract rated five stars overall can still serve only a handful of counties, or none near a given client. Checking local availability first avoids pitching a plan the client cannot actually join.
What Happens If a Client Switches to a Stand-Alone 5-Star Drug Plan?
Switching into a five-star plan carries a real coverage risk, not just a plan change. Consider a client in a Medicare Advantage plan with drug coverage who uses the 5-star SEP to join a stand-alone five-star Part D plan. The Medicare Advantage plan ends automatically, medical benefits included, and Medicare.gov's Special Enrollment Periods page confirms the client returns to Original Medicare for hospital and doctor visits. The reverse move carries a different risk. A client who leaves Medicare Advantage drug coverage for a five-star Medicare Advantage plan with none can lose prescription coverage until the next enrollment chance, and may owe a Part D late enrollment penalty. Either direction, the SEP moves one plan at a time, not a client's whole coverage picture, so confirming what each side actually includes matters as much as confirming the star rating itself.
| Client's current plan | What the 5-star SEP allows | What they risk |
|---|---|---|
| Medicare Advantage with drug coverage | Switch to a stand-alone 5-star Part D plan | Automatic disenrollment from the MA plan; returns to Original Medicare for medical care |
| Medicare Advantage with drug coverage | Switch to a 5-star MA plan without drug coverage | Loses Part D coverage until the next enrollment chance; possible late-enrollment penalty |
| Stand-alone Part D plan | Switch to a 5-star MA plan with drug coverage | Leaves Original Medicare for a Medicare Advantage network |
Is a 5-Star Plan Available in the Client's County?
Checking county-level availability is the step most agents skip. It is also the step that keeps this SEP from becoming a wasted conversation. AgencyView's free Medicare Plans by County pages list every plan serving a county next to its CMS star rating. An agent can confirm a five-star option actually exists there before raising the SEP with a client. The same pages offer a free email alert when a county's average star rating or plan count changes year over year. That alert catches a county gaining, or losing, its only five-star option.
Why Would an Agent Raise This SEP With a Client?
Most clients never hear about the 5-star SEP, since it falls outside AEP, when agents are busiest. A client stuck for several years in a plan rated three stars or lower is a reasonable candidate for the conversation. So is a client whose current plan just dropped a star while a nearby contract gained one. The SEP also matters for a client who moves into a county where a five-star plan happens to be available. Without this SEP, that option would wait until the next Annual Enrollment Period. Our broader look at SEP triggers agents miss outside AEP covers the rest of the triggers that come up between enrollment seasons.
Before You Suggest the 5-Star SEP
- Confirm a plan with a current overall five-star rating actually serves the client's county, not just the carrier's broader book.
- Identify the direction of the move. MA-PD to stand-alone PDP, MA to MA, and PDP to MA-PD each carry different consequences for medical and drug coverage.
- Confirm the client has not already used the 5-star SEP once this contract year.
- Record the Scope of Appointment and the reason for the switch the same way you would for any other enrollment.
- Note the effective date for the client. Coverage starts the first day of the month after the plan receives the request, not immediately.
Example: a five-agent Medicare agency reviews its book every October when CMS releases new ratings. One agent notices three long-time clients sitting in a contract that slipped from four stars to two and a half. A nearby five-star contract now serves their county for the first time. The agency flags those three clients for a 5-star SEP conversation, then checks each client's drug list against the new plan's formulary. The agent documents the Scope of Appointment before making any changes. None of the three clients is enrolled without that check, since a star rating alone does not confirm a client's specific drugs and doctors are covered.
Does a Plan Keep Its Five Stars the Following Year?
A star rating is reassessed every year and never carried forward. CMS recalculates the measures and the cut points annually. A contract that qualifies a client for the 5-star SEP this year may not qualify next year. A contract with four stars this year could reach five the next. Eligibility for this SEP always follows the plan's current contract-year rating. Checking the rating at the time of the conversation, not from memory of a prior year, is part of using this SEP correctly.
Tracking which clients sit in a plan below four stars is tedious by hand. So is tracking which counties pick up a new five-star option each fall. A Medicare agent CRM that tags a client's current plan and its rating turns that annual research project into a filtered list instead.
Frequently Asked Questions
Can a client use the 5-star SEP more than once a year?
No. A client may use the 5-star SEP only once within the contract year the plan holds its five-star rating. That year runs from December 8 of the prior year through November 30.
Does the 5-star SEP still matter during AEP?
During the Annual Enrollment Period, a client can already switch plans for any reason. The 5-star SEP adds little then. Its value shows up the rest of the year, when AEP is closed and a five-star option is the only reason left for a mid-year change.
What if no five-star plan serves the client's county?
Then the SEP is not available to that client, even though it exists nationally. Five-star eligibility is set at the contract level. A contract can hold five stars overall while serving only part of the country.
Does the 5-star SEP apply to Medigap policies?
No. Medigap policies do not receive a CMS star rating. This SEP only covers Medicare Advantage, Medicare Advantage with drug coverage, stand-alone Part D, and Medicare Cost plans.
When did CMS release the 2027 star ratings?
CMS released the 2027 Medicare Advantage and Part D Star Ratings on October 8, 2026. That was just ahead of the Annual Enrollment Period, which ran from October 15 through December 7, 2026.
Does the plan's rating at sign-up or at the next contract year control?
The rating at sign-up controls. The SEP keys off the rating the contract holds for the current contract year, the same year the client is switching into, not a rating it may earn or lose later.
AgencyView keeps a client's current plan and coverage type on their contact record. The free Medicare Plans by County pages turn checking local five-star availability into a lookup instead of a research project. See how AgencyView compares every Medicare plan type in a client's county during AEP for the same tool at work in the busier season. Learn more at agencyview.net.
Where AgencyView fits
Keep reading
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- Medicare SEP Triggers Agents Miss Outside AEP
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