In 2026, CMS awarded 5-star overall ratings to fewer than 5 percent of Medicare Advantage contracts nationwide. That is a small number of plans, and not all counties have one available. But for brokers who know where those plans are and which clients qualify to enroll, the 5-star special enrollment period is the one MA enrollment window that stays open for nearly 12 consecutive months.
Most brokers are focused on AEP and OEP. The 5-star SEP, which opens December 8 and runs through November 30, rarely comes up in carrier sales calls or compliance training. That is the gap.
Key Takeaways
- The 5-star SEP is available to any Medicare beneficiary enrolled in a Medicare Advantage, MA-PD, or Part D plan that earned fewer than 5 stars, as long as a 5-star plan is available in their service area. It opens December 8 each year and runs through November 30 of the following year.
- In 2026, CMS awarded 5-star ratings to a small minority of Medicare Advantage contracts. Not every county has one available. A broker cannot use this SEP if the client's county has no 5-star plan.
- The SEP allows exactly one election per calendar year. Using it in January does not prevent use in the same calendar year for a different reason, but a second 5-star SEP use in the same year is blocked.
- Part D standalone PDPs also qualify for the 5-star SEP. Beneficiaries in Original Medicare with low-rated PDPs can switch to a 5-star PDP outside of open enrollment using this window.
- The 5-star plan must have received a 5-star overall contract rating from CMS for the year in which the SEP is used. Plans with an overall 4.5-star rating do not qualify. CMS uses whole-number ratings for SEP eligibility, not half-stars.
How the 5-star SEP works
The 5-star SEP is a plan-specific special enrollment period created by CMS to reward top-rated Medicare Advantage and Part D plans with year-round enrollment access. A Medicare beneficiary currently enrolled in any MA, MA-PD, or standalone PDP plan can use the SEP to switch into a 5-star plan, as long as a 5-star plan is available in their county of residence and they have not already used this SEP in the current calendar year.
The SEP opens December 8, the day after the Annual Enrollment Period closes, and stays open through November 30 of the following year. Coverage under a 5-star enrollment starts on the first of the month following the enrollment date. An enrollment submitted on April 7 produces May 1 coverage.
For context on how the 5-star SEP fits alongside AEP and the MA OEP, the Medicare enrollment windows guide covers AEP, OEP, and plan-specific SEPs in one place.
Which plans qualify
CMS assigns star ratings at the contract level (the H number), not at the individual plan or county level. A single contract may include dozens of plan designs across multiple counties. All of those plans qualify for the 5-star SEP if the parent contract receives a 5-star overall rating from CMS.
CMS publishes star ratings each October for the following plan year. The list is available through Medicare Plan Finder and through direct CMS data downloads. Brokers should pull the annual 5-star contract list in October, identify which contracts operate in their service counties, and cross-reference that against their book of business before AEP ends.
A few important eligibility boundaries:
- Plans rated 4.5 stars do not qualify. The 5-star SEP requires a whole-number 5-star overall contract rating. CMS uses whole numbers for SEP eligibility, not the half-star increments it publishes publicly.
- New plans without a prior year star rating are excluded. CMS assigns a 5-star rating only to contracts with a full year of quality data. A new MA plan in its first contract year does not qualify, even if the parent organization has other 5-star contracts.
- Part D standalone plans are included. Beneficiaries in Original Medicare with a low-rated PDP can use the 5-star SEP to switch to a 5-star PDP at any point from December 8 through November 30, without waiting for AEP.
The prospecting workflow that most brokers skip
Every October, CMS publishes a new star rating list. Within days of that release, a broker who has downloaded the data knows which contracts earned 5 stars in which service areas. That is a targeting list for the next 12 months.
The workflow is:
- Download the CMS Medicare Plan Finder star rating data or the CMS public use file for the current plan year.
- Filter for 5-star contracts operating in your service counties.
- Pull the list of clients currently enrolled in plans on those same contracts rated 3, 3.5, or 4 stars.
- Reach out starting December 8 with a specific comparison: the client's current plan versus the available 5-star alternative, with premium, out-of-pocket, and network differences highlighted.
The 5-star SEP does not require that the client be dissatisfied. It requires only that the target plan has a 5-star rating and is in the client's county. A proactive reach-out in December or January, before the client hears from a competing broker running the same playbook, is the practical value of knowing the window is open.
What the 5-star SEP does not allow
The SEP is one election per calendar year. A client who uses the 5-star SEP in February to switch into a 5-star plan cannot use a second 5-star SEP in October to switch to a different 5-star plan in the same year. The calendar-year limit is firm.
| Enrollment window | Open dates | What it allows | Times per year |
|---|---|---|---|
| AEP | Oct 15 — Dec 7 | Any plan change: switch, drop, or enroll in any MA or PDP | One enrollment effective Jan 1 |
| MA OEP | Jan 1 — Mar 31 | MA enrollees only: switch to different MA plan or return to Original Medicare + PDP | One election |
| 5-Star SEP | Dec 8 — Nov 30 | Switch to any available 5-star MA, MA-PD, or PDP plan in the service area | One election per calendar year |
Window dates and rules reflect CMS guidance for 2026. Verify availability of 5-star plans in a specific county through Medicare Plan Finder before confirming eligibility with a client.
The 5-star SEP also does not apply to enrolling a beneficiary who is not yet in a Medicare Advantage or Part D plan. A beneficiary in Original Medicare without any PDP cannot use the 5-star SEP to enroll in a Medicare Advantage plan for the first time. That enrollment belongs to the Initial Enrollment Period or a qualifying SEP. The Initial Enrollment Period guide covers first-time enrollment timing.
Switching from Original Medicare to MA under the 5-star SEP is not permitted. The SEP applies to beneficiaries already enrolled in an MA, MA-PD, or standalone PDP who want to switch to a 5-star plan in the same category.
When counties have no 5-star plan
In counties where no 5-star MA plan or PDP is available, the SEP simply cannot be used. Brokers who work in markets with smaller carrier footprints may find that none of the available plans in a county achieved 5 stars in a given year. CMS publishes the county-level availability data in the Plan Finder search tool.
When a 5-star plan is not available in a client's county and the standard enrollment windows are closed, the options are a qualifying SEP (loss of coverage, plan non-renewal, move to new service area, low-income subsidy, or other qualifying event) or waiting for AEP. Quotit does not advertise 5-star SEP county availability tools or workflow guidance on its public features page as of August 2026.
Frequently asked questions about the Medicare Advantage 5-star SEP
What brokers ask most often when working with the 5-star enrollment window.
When does the Medicare Advantage 5-star SEP open and close?
The 5-star SEP opens December 8 each year, the day after the Annual Enrollment Period closes on December 7. It remains available through November 30 of the following year. This means a beneficiary has nearly a full year to use the SEP, from December 8 through the day before the next December cycle begins. Coverage under a 5-star SEP enrollment typically starts the first of the month following the enrollment date. A beneficiary who enrolls in a 5-star plan on March 15 would have coverage effective April 1. The window is separate from the Medicare Advantage Open Enrollment Period (January 1 through March 31), which only allows switching out of a Medicare Advantage plan back to Original Medicare or to a different MA plan.
Who qualifies to use the Medicare Advantage 5-star SEP?
Any Medicare beneficiary who is enrolled in a Medicare Advantage, MA-PD, cost plan, or standalone Part D plan qualifies to use the 5-star SEP, with three conditions: the beneficiary must be switching into a plan rated 5 stars overall by CMS for the current year, a 5-star plan must be available in the beneficiary's service area (the county where they reside), and they must not have already used a 5-star SEP election in that calendar year. Beneficiaries in Original Medicare without a PDP can use the SEP to enroll in a 5-star Part D standalone plan. Beneficiaries already enrolled in a 5-star plan cannot use the SEP to switch to a different 5-star plan in the same year. The client does not need to show a qualifying event, loss of coverage, or any specific change in circumstances. The 5-star rating is the qualifying condition.
How does CMS determine which plans earn 5-star ratings?
CMS calculates Medicare Advantage star ratings annually using a weighted average of measures across five broad domains: staying healthy (screening tests and vaccines), managing chronic conditions, member experience, member complaints and call center performance, and health plan administrative operations. The Part D component of the rating covers drug pricing accuracy, drug safety, member experience with drug plans, and call center performance. CMS publishes individual measure scores, domain weights, and the resulting overall contract rating each October for the plan year beginning January 1. Plans are rated at the contract level, not at the individual plan benefit level, meaning all plans under the same H contract receive the same star rating. A contract with multiple plan designs in multiple counties will qualify for or be excluded from the 5-star SEP based on its overall contract rating, not individual plan performance.
Can a broker use the 5-star SEP for a client who is not dissatisfied with their current plan?
Yes. The 5-star SEP does not require that the beneficiary be unhappy with their current plan. The only eligibility condition is that the beneficiary's target plan has a 5-star overall CMS rating and is available in their county. A client who is satisfied with a 4-star plan can still use the SEP to move to a 5-star plan if one is available in their area. Brokers often use this window proactively: after CMS releases star ratings in October, identify which clients are on plans rated 3, 3.5, or 4 stars in counties where a 5-star plan is available, and reach out with a specific comparison. This is a retention-adjacent workflow: you initiate the conversation before the client hears from a competitor who found the same data.
What happens if no 5-star plan is available in a client's county?
If no Medicare Advantage or Part D plan rated 5 stars is available in the beneficiary's county of residence, the 5-star SEP cannot be used for that client in that year. CMS does not provide an alternative SEP when a 5-star plan is unavailable. The beneficiary must wait for AEP (October 15 through December 7) or qualify for a different SEP (such as moving to a new service area, losing coverage, or qualifying for low-income subsidy) to make a plan change outside the standard windows. Brokers should download the CMS 5-star plan list each October and filter it against their service counties before scheduling outreach calls. A county-by-county filter is the only way to know whether the 5-star SEP is a viable tool for a given client. Quotit does not advertise 5-star SEP workflow or county availability tools on its public features page as of August 2026.
