Dear Marci,
I just found out there’s a Medicare Advantage plan in my area with a five-star quality rating. Can I leave my old plan and join that plan?
-- Erin (Redwood City, CA)
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Dear Erin,
Yes, you can. Starting in 2012, there’s a new a Special Enrollment Period (SEP) that you can use at any point in the year to enroll in a Medicare Advantage plan or stand-alone Part D plan with a five-star rating.
The star rating is an overall performance rating that the government gives to all Medicare plans based on measures such as customer service, pricing and member satisfaction. On a scale of one to five, a one-star rating represents poor performance and a five-star rating represents excellent performance.
To use this Special Enrollment Period to enroll in a five-star plan, you must meet the plan’s membership requirements and live in its service area. There are very few five-star plans in 2012, so they’re not available in all areas. However, the ratings get updated every year so your five-star options may change from year to year.
There are a few things you should keep mind if you’re thinking about using the five-star Special Enrollment Period.
Most importantly, think about how the plan will affect your access to health care and prescriptions for the rest of the year. Just because a plan has a five-star rating doesn’t mean it’s the best option for you. If you like the plan you’re in now and it works for you, there’s no reason to change. A plan with a high rating won’t benefit you if your drugs aren’t on the plan’s formulary or your doctors aren’t in the plan’s network. The Medicare Rights Center has some checklists that can help you find out the costs, coverage rules and restrictions of a Medicare Advantage plan or stand-alone drug plan before you enroll.
Also consider how enrolling in the five-star plan may affect your other benefits. For example, signing up for a five-star Part D plan could affect your health coverage if you have a Medicare Advantage plan or retiree coverage.
Lastly, you should be aware that the Special Enrollment Period can only be used once a year, and then you must generally stay with that plan for the rest of the calendar year (unless you qualify for a different Special Enrollment Period). You have until November 30 to enroll in a plan that has a five-star rating in 2012, and your new coverage starts the first of the month after you enroll.
To find out which five-star plans are available in your area or enroll in a plan, call 800-MEDICARE or go to www.medicare.gov. To learn more about the five-star rating, see Medicare’s “Choose Higher Quality for Better Health Care” information sheet.
—Marci
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Looking for past Dear Marci Answers? Have other Medicare questions? Find your answers with Medicare Interactive (MI), an independent, public resource of the Medicare Rights Center. MI offers expert information and advice on Medicare. Visit Medicare Interactive today! |
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Do you need individual counseling? Call the Medicare Rights Center's consumer helpline at 800-333-4114, between 9 a.m. and 5 p.m., Eastern Time, Monday through Friday. A Medicare counselor will be happy to answer your question.
You can also call your State Health Insurance Assistance Program (SHIP) for personal counseling on Medicare benefits, rights and options. Call Social Security (800-772-1213) for questions about enrolling in Medicare or applying for Extra Help!
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Health Tip
Glaucoma, a group of eye diseases in which damage to the optic nerve leads to vision loss, can affect any people in any age group. Because glaucoma makes the eyesight deteriorate gradually, people who have it may not notice until it has reached advanced stages. Up to 40% of your vision can be lost without you noticing, according to the Glaucoma Research Foundation.
Some people are at higher risk for glaucoma, including older people, people with a family history of glaucoma, and people with certain medical conditions such as diabetes, according to the Mayo Clinic.
January is Glaucoma Awareness Month. Whether or not you’re at high risk for the disease, you can follow these tips from the Mayo Clinic to help prevent glaucoma and the irreversible vision damage it causes:
- Get regular eye exams: Catching glaucoma in its early stages helps you get treatment to help slow or prevent further vision loss. Medicare covers 80 percent of the cost of an annual glaucoma screening if you are at high risk for the disease.
- Treat elevated inner eye pressure. If you have high inner eye pressure, using certain eye drops can reduce your risk of developing glaucoma.
- Control your weight and blood pressure. Studies have shown that insulin resistance — which may result from hypertension and obesity — is linked to elevated intraocular pressure.
- Wear eye protection. Wear eye protection to prevent serious eye injuries that can lead to glaucoma.
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