Medicare beneficiaries are generally locked into their plan choices after the Annual Enrollment Period closes each December 7. One powerful exception exists: the 5-Star Special Enrollment Period. CMS publishes star ratings for every Medicare Advantage and Part D plan each fall, scoring plans on quality of care, member satisfaction, chronic condition management, customer service, and complaint rates. Plans that earn a perfect 5-star overall rating unlock a rare year-round enrollment right for any Medicare beneficiary who lives in their service area. For 2026, CMS awarded 5-star designation to 21 total contracts: 18 Medicare Advantage Prescription Drug (MA-PD) contracts, one Medicare Cost Plan contract, and two standalone Part D drug plan contracts. If one of those plans covers your county, you can switch into it almost any day from December 8, 2025 through November 30, 2026, and your new coverage starts the first of the following month. No triggering life event required, no waiting for next October.
Three rules make this SEP more nuanced than it first appears. First, geographic availability is narrow: in 2026, 5-star plans are available in roughly 19 states and Puerto Rico, and even within those states, coverage depends on your specific county. Second, the SEP can only be used once per December 8 to November 30 window, not unlimited times during the year. Third, switching from a Medicare Advantage Prescription Drug plan to a standalone Part D plan using this SEP disenrolls you from Medicare Advantage entirely and returns you to Original Medicare, which may not be your intention. Before enrolling, confirm the 5-star plan's provider network includes your doctors, verify your prescriptions are covered on the plan's formulary, and check total annual costs including Part B premium ($202.90 per month in 2026), plan premium, copays, and drug costs. The Medicare Plan Finder at medicare.gov compares all of these figures side by side. State Health Insurance Assistance Programs (SHIPs) offer free, unbiased counseling if you need a second opinion before switching.
7 Steps to Get Coverage
Common Mistakes That Cost People Thousands
The most costly mistakes beneficiaries make when attempting to use the 5-Star SEP:
- Assuming a 5-star plan is available just because the state has one. Availability is county-specific. A plan rated 5 stars in Florida may only cover certain counties. Always enter your ZIP code in the Medicare Plan Finder at medicare.gov to confirm local availability before starting the enrollment process.
- Using the 5-Star SEP to switch from an MA-PD plan to a standalone Part D plan, not realizing the MA-PD disenrollment is total. Switching from a Medicare Advantage Prescription Drug plan to a standalone PDP using this SEP returns you to Original Medicare for all health coverage, which may require enrolling in a Medigap policy (and missing the guaranteed-issue window permanently if you have health conditions).
- Trying to use the SEP more than once. The 5-Star SEP can only be used once per December 8 to November 30 window. A second switch attempt in the same window will be rejected. If you need to switch again, you must wait for the Annual Enrollment Period (October 15 to December 7).
- Not verifying doctor and hospital network before switching. A 5-star rating measures plan quality and member satisfaction, not the breadth of its network. Your primary care doctor, cardiologist, or oncologist may not participate in the 5-star plan's network, leading to full out-of-network costs or having to restart care with new providers.
- Ignoring prescription drug formulary changes. Switching to a 5-star plan that does not cover your medications at a preferred tier can increase your out-of-pocket drug costs significantly, even with the 2026 Part D out-of-pocket cap of $2,100. Compare your drug list on the new plan's formulary before submitting the enrollment request.
- Canceling the old plan before new coverage begins. Your existing Medicare plan terminates automatically the day before your new 5-star plan starts. Manually canceling your current plan first creates a gap in coverage. Never send a disenrollment notice to your current plan, just submit the enrollment request to the new plan.
How CMS Calculates 5-Star Ratings: What the Score Actually Means
CMS star ratings measure plan performance across up to 9 domains and 45 individual measures for MA-PD contracts. The domains include staying healthy (screenings, tests, vaccines), managing chronic conditions, member experience with the health plan, member complaints and changes in the plan's performance, and health plan customer service. For standalone Part D plans, ratings cover drug plan quality (4 domains, up to 12 measures). A perfect 5-star overall score means the plan ranked in the highest tier on a weighted composite of all applicable measures using CMS's cut-point methodology. CMS applies several guardrails in the rating calculation: new plans in their first two years receive a star rating based on limited data, and plans with very small enrollment may have ratings suppressed due to insufficient sample size. For 2026, the total number of 5-star contracts dropped from 2025 to 21 (from a higher count in prior years), reflecting tighter cut-points and methodological changes CMS finalized in the 2027 rate notice published April 2026.
What a 5-star rating does NOT guarantee: specific provider participation, broad formulary coverage, or $0 premiums. Star ratings are backward-looking, based on 2024-2025 plan performance data. A plan with a 5-star 2026 rating was scored on the prior plan year's quality metrics. Networks and formularies are set for 2026 by the plan and can change independently of star ratings. Always verify the 2026 Evidence of Coverage document against your specific care needs. If a plan holds 5 stars in one contract year but drops to 4.5 stars in the next year's ratings, it immediately loses 5-Star SEP eligibility for the following December 8 to November 30 window.
5-Star SEP vs. Annual Enrollment Period vs. Medicare OEP: Which Window to Use
Three Medicare enrollment windows exist for plan switching in 2026. The Annual Enrollment Period (AEP) runs October 15 to December 7 each year and allows the broadest switching rights: any beneficiary can switch between any MA plans, between any Part D plans, drop MA and return to Original Medicare, or add a Part D plan. The Medicare Open Enrollment Period (OEP) runs January 1 to March 31 and allows one switch from an MA plan to another MA plan or back to Original Medicare (with or without a Part D plan). The 5-Star SEP runs December 8 through November 30 and allows one switch into a 5-star plan only. The practical decision rule: if a 5-star plan is available in your county and passes the network and cost tests described in the steps above, the 5-Star SEP lets you act now rather than waiting until next October. If no 5-star plan is available, wait for the AEP (opens October 15, 2026 for 2027 coverage) or watch for other qualifying SEPs (moving to a new service area, losing coverage, nursing-home residency, low-income status, or prior-plan contract termination all trigger their own SEPs).
Medicare Plan Switching Windows Comparison, 2026| Window | Dates | Who can use it | How many times |
|---|
| Annual Enrollment Period (AEP) | Oct 15 - Dec 7, 2026 | All Medicare beneficiaries | Once per AEP |
| Medicare Open Enrollment Period (OEP) | Jan 1 - Mar 31, 2026 | Beneficiaries currently in an MA plan | Once per OEP |
| 5-Star SEP | Dec 8, 2025 - Nov 30, 2026 | Beneficiaries who live in a 5-star plan's service area and are NOT already in a 5-star plan | Once per Dec 8 to Nov 30 window |
| Loss-of-Coverage SEP (e.g., plan exits market) | Within 60 days of coverage loss | Beneficiaries whose plan terminates, moves out of service area, or loses a qualifying contract | As triggered |
Sources: medicare.gov, CMS 2026 enrollment guidance. 5-Star SEP requires a 5-star plan to be available in your county. AEP and OEP have no geographic restrictions.
Source: Medicare.gov, CMS 2026 MA enrollment guidance, 42 CFR 422.62
Documents Needed to Enroll Using the 5-Star SEP
Enrolling in a 5-star plan through the 5-Star SEP requires minimal documentation compared to other SEPs. No proof of a qualifying life event is required because geographic eligibility (living in the plan's service area) is the sole prerequisite. Still, have these items ready to complete the enrollment form accurately: your Medicare Beneficiary Identifier (MBI), printed on your red, white, and blue Medicare card; your Part A and Part B enrollment dates (also on the card or available at mymedicare.gov); your current plan name and plan ID so you can confirm the switch; and a list of your current prescriptions (drug name, dose, and frequency) to verify formulary coverage on the new plan before confirming. If you receive Extra Help (Low-Income Subsidy), also have your LIS eligibility confirmation letter ready, as Extra Help status affects Part D copay tiers on the new plan.
Medicaid Dual-Eligibility and D-SNP Option for Low-Income Beneficiaries
Medicare beneficiaries with incomes under approximately 138% of the Federal Poverty Level in the 40 Medicaid expansion states plus DC may qualify for both Medicare and Medicaid simultaneously, known as dual eligibility. For 2026, 138% FPL for a single person is approximately $22,025 annually. Dual-eligible beneficiaries can enroll in a Dual Eligible Special Needs Plan (D-SNP), which coordinates Medicare and Medicaid benefits and often provides $0 premiums, $0 drug copays, and extra benefits like dental, vision, and transportation. D-SNPs are a separate category from 5-star plans and have their own year-round enrollment rules for qualifying beneficiaries. If you are dual-eligible, compare D-SNP options against any available 5-star MA-PD plan before using the 5-Star SEP. Many D-SNPs are also highly rated but not necessarily 5-star. State Medicaid agencies handle the Medicaid portion of dual-enrollment and can confirm year-round enrollment availability in your state.
Frequently Asked Questions
What is the 5-Star Medicare SEP and when can I use it?
The 5-Star Special Enrollment Period (SEP) lets any Medicare beneficiary switch to a Medicare Advantage, MA-PD, standalone Part D, or Medicare Cost Plan that holds a 5-star overall CMS rating, almost any day of the year. The window runs December 8 through November 30 of the following year. For the 2026 contract year, that means you can enroll from December 8, 2025 through November 30, 2026. You must live within the plan's service area and cannot already be enrolled in a 5-star plan. You can use this SEP only once per December 8 to November 30 period, not multiple times.
How do I find out if a 5-star Medicare plan is available in my area for 2026?
Use the Medicare Plan Finder at medicare.gov/plan-compare and enter your ZIP code. Plans with a 5-star overall rating are labeled with a star icon. For 2026, CMS awarded 5-star status to 21 total contracts, available in roughly 19 states and Puerto Rico, including Florida, Texas, North Carolina, Michigan, Pennsylvania, New York, Massachusetts, Colorado, Virginia, New Jersey, Georgia, South Carolina, Kansas, Maryland, and Iowa. Availability is county-specific, not just statewide. You can also call 1-800-MEDICARE (1-800-633-4227) and a representative can verify available 5-star plans by your ZIP code.
What happens if I switch from an MA-PD plan to a standalone Part D plan using the 5-Star SEP?
Switching from a Medicare Advantage Prescription Drug plan to a standalone Part D plan using the 5-Star SEP disenrolls you completely from Medicare Advantage, including all health benefits. You return to Original Medicare (Parts A and B) for all medical services. If you do not have a Medigap policy, you would be exposed to Original Medicare's 20% coinsurance and the Part A hospital deductible of $1,736 (2026). Most beneficiaries who want to add or upgrade a drug plan while keeping Medicare Advantage should look for a 5-star MA-PD plan instead. If no 5-star MA-PD plan is available in your county, the Annual Enrollment Period (October 15 to December 7) allows you to switch both health and drug coverage.
How many times can I use the 5-Star SEP in 2026?
You can use the 5-Star SEP only once per December 8 to November 30 window. For 2026, the window is December 8, 2025 through November 30, 2026. A second switch attempt using this SEP during the same window will be denied. If you enrolled in a 5-star plan during the 2026 window but are dissatisfied, you must wait for the Annual Enrollment Period (October 15 to December 7, 2026) to switch again, or qualify for another SEP such as a plan-exit SEP if your plan terminates.
When does my coverage start after I enroll in a 5-star plan using the SEP?
For enrollment requests submitted January 1 through November 30, coverage starts on the first day of the month after the plan receives your request. For example, an application received by the plan on June 10, 2026 produces coverage starting July 1, 2026. For enrollments made December 8 through December 31, coverage starts January 1 of the new contract year. Your old plan terminates automatically the day before your new coverage starts. Do not manually cancel your current plan, as doing so before the new plan starts would create a coverage gap.
Does a 5-star rating mean the plan will cover my doctors and prescriptions?
Not automatically. CMS star ratings measure quality on metrics like preventive screenings, chronic disease management, member satisfaction, and customer service. The rating does not guarantee that your specific doctors, hospitals, or pharmacies are in the plan's 2026 network, and it does not mean your prescriptions are covered at a preferred formulary tier. Before using the 5-Star SEP, verify your primary care physician, specialists, and preferred pharmacy in the plan's provider directory, and check your drugs on the plan's 2026 formulary at medicare.gov/plan-compare. A plan that earns 5 stars but excludes your cardiologist or places your maintenance drugs at a non-preferred tier may cost you more than your current plan despite the rating.
Can I use the 5-Star SEP if I have both Medicare and Medicaid (dual eligible)?
Dual-eligible beneficiaries who qualify for both Medicare and Medicaid have additional year-round enrollment rights beyond the 5-Star SEP, including continuous enrollment in Dual Eligible Special Needs Plans (D-SNPs). For 2026, the Medicaid expansion income threshold is approximately 138% FPL, which is about $22,025 for a single person. If you are dual eligible, compare D-SNP options as well as 5-star MA-PD plans before deciding. D-SNPs typically offer $0 or very low premiums and coordinated Medicaid and Medicare benefits. Contact your state Medicaid agency year-round to confirm dual-eligibility status and D-SNP availability in your county.
What if I miss the 5-Star SEP window or no 5-star plan is available in my county?
If no 5-star plan is available in your county, the 5-Star SEP does not apply to you this year. Your next opportunity for broad plan switching is the Annual Enrollment Period, which runs October 15 through December 7, 2026 for 2027 coverage. During that window, you can switch among all MA plans and Part D plans without restriction. If you have a specific qualifying event (moving to a new county, losing coverage, entering a nursing home, or qualifying for low-income programs), those events trigger their own separate SEPs with their own timelines at medicare.gov.
