The Medicare 5-Star Rating Special Enrollment Period (5-Star SEP) is the federal special enrollment period that lets Georgia Medicare beneficiaries enroll, year-round, in a Medicare Advantage plan, MA-PD plan, or standalone Part D plan that has earned the highest CMS Quality Star Rating, available once per year outside the standard Annual Enrollment Period (AEP) and Medicare Advantage Open Enrollment Period (MA OEP) windows.

What the 5-Star SEP Is

The 5-Star SEP is unique among Medicare enrollment pathways because:

  1. It is the only enrollment pathway tied to quality performance rather than life circumstances (moving, losing coverage, becoming eligible for Medicaid, etc.)
  2. It is available year-round, outside AEP and beyond the standard MA OEP window
  3. It can be used once per contract-year cycle by a given beneficiary
  4. The switch is generally effective the first of the following month after the enrollment request
  5. It applies only to plans rated at the highest Star Rating (5.0 stars)

The 5-Star SEP is authorized under the Social Security Act and implemented under CMS Medicare Advantage and Part D enrollment regulations. The detailed statutory and regulatory citations and the current operational windows are available on the Medicare.gov enrollment page and in CMS's annual guidance.

The 5-Star SEP exists as part of the broader CMS quality framework. It complements the Quality Bonus Payment Program (QBP) by adding an enrollment-side advantage to 5-star plans. While higher-rated plans share in the QBP bonus pool, only plans rated at the top of the scale qualify for the year-round 5-Star SEP. That is the unique competitive advantage of reaching 5 stars.

For Georgia beneficiaries, the 5-Star SEP is operationally important when a 5-star MA plan or 5-star Part D PDP becomes available in their county. The 5-Star SEP lets them switch into that plan at any point during the year without waiting for AEP, but only if they have not already used the SEP in the current cycle.

Why the 5-Star SEP Year-Round Window Matters in Georgia

The 5-Star SEP matters in Georgia because:

Georgia MA enrollees and standalone Part D enrollees can potentially use the 5-Star SEP whenever a 5-star plan serves their county and they have not used the SEP yet this cycle.

5-star availability changes annually: CMS Star Ratings refresh each October. A plan that is 5 stars this year might drop a half-star next year (or vice versa). Beneficiaries who want to use the 5-Star SEP should verify current-year status on Medicare.gov Plan Finder.

The 5-Star SEP coordinates with QBP: Higher Star Ratings share in the Quality Bonus Payment pool, but only 5-star status unlocks the year-round 5-Star SEP. Plans pursue 5-star status partly for the SEP enrollment growth advantage.

The 5-Star SEP does not depend on life circumstances: Unlike most SEPs (moving, losing other coverage, becoming Medicaid-eligible, etc.), the 5-Star SEP requires no qualifying life event. Just a 5-star plan in your service area and no prior 5-Star SEP use this cycle.

It is a beneficiary-friendly mechanism: It lets beneficiaries upgrade to top-rated plans without waiting for AEP. Particularly valuable if benefit gaps or care quality issues emerge mid-year.

It supports plan competition on quality: Plans compete for 5-star status because of the enrollment advantage, which pushes plans to invest in quality.

For Georgia eldercare specifically:

  • A large Medicare beneficiary population statewide
  • Substantial Medicare Advantage enrollment
  • Many standalone Part D enrollees
  • Star Ratings refresh annually in October
  • Specific 5-star plans available in Georgia vary year-to-year
  • GeorgiaCares SHIP at 1-866-552-4464 provides free 5-Star SEP counseling
  • Georgia Senior Medicare Patrol monitors 5-Star SEP-related marketing fraud

The 5-Star SEP rests on Medicare Advantage and Part D enrollment authority under the Social Security Act and CMS's implementing regulations. The substantive elements:

  • MA 5-Star SEP statutory authority in the Social Security Act provides that beneficiaries may enroll in a 5-star MA plan during a special enrollment period outside the standard windows.
  • Part D 5-Star SEP statutory authority is a parallel provision for standalone Part D Prescription Drug Plans.
  • CMS MA enrollment regulations specify the operational window, the once-per-cycle limit, the first-of-following-month effective date convention, and the 5.0-star plan eligibility requirement.
  • CMS Part D enrollment regulations carry parallel provisions for standalone Part D.
  • CMS Annual Rate Announcement and Call Letter: Annual policy guidance addressing 5-Star SEP operational details, Star Ratings methodology refinements, and any policy adjustments.
  • CMS Quality Star Ratings Methodology: The framework that determines which plans qualify as 5.0 stars. Ratings are calculated across measures spanning HEDIS clinical quality, CAHPS member experience, HOS health outcomes survey, and CMS administrative data. Part C and Part D summary ratings are combined into an overall plan-level Star Rating released annually in October.
  • CMS Medicare Communications and Marketing Guidelines (MCMG): Marketing rules for 5-Star SEP-related communications, including required disclosures and prohibitions on misleading claims.
  • Quality Bonus Payment Program authority: The 5-Star SEP coordinates with QBP but is operationally distinct.

For the current statutory cross-references, CFR sections, and operational windows, consult the Medicare.gov enrollment page and CMS's annual Call Letter.

The 5-Star SEP Window

The 5-Star SEP operates on the Medicare contract-year calendar:

Date Event
October each year CMS releases annual Star Ratings
October 15 to December 7 AEP; beneficiaries make plan selections for the following year
Early December 5-Star SEP opens for the new contract year
January 1 New plan year begins; new Star Ratings in effect
January 1 to March 31 MA OEP overlap (eligible MA enrollees can use either MA OEP or 5-Star SEP)
Late November 5-Star SEP closes for the current contract year
Following early December New 5-Star SEP window opens based on new Star Ratings

Key operational notes:

  • The 5-Star SEP window for any given contract year runs essentially year-round outside the AEP overlap. Verify the exact start and end dates on Medicare.gov.
  • 5-Star SEP eligibility is based on the current contract year's Star Ratings (released the prior October).
  • A plan that earns 5 stars in October becomes 5-Star SEP eligible when the new contract-year ratings take effect.
  • A plan that drops below 5 stars in October loses 5-Star SEP eligibility when the new ratings take effect.

5-Star SEP Eligibility Requirements

To use the 5-Star SEP, a beneficiary must meet all of the following:

  1. Entitled to Medicare: Part A + Part B for MA/MA-PD enrollment; Part A or Part B for standalone Part D enrollment.

  2. A 5-star plan is available in your service area: At least one MA plan, MA-PD plan, or standalone Part D PDP rated 5.0 stars for the current contract year serves your county.

  3. 5-Star SEP has not been used yet in the current contract-year cycle.

  4. The receiving plan is rated 5.0 stars at the time of enrollment: lower-rated plans (including 4.5-star plans) do not qualify; the rating must be the top tier.

If all four conditions are met, the beneficiary can use the 5-Star SEP to enroll in the 5-star plan.

5-Star SEP Mechanics

Once Per Cycle

The 5-Star SEP can be used once per contract-year cycle. After one use, the SEP is unavailable until the following cycle opens (when new Star Ratings take effect).

First-of-Following-Month Effective Date

Enrollment requests made via the 5-Star SEP are generally effective the first of the following month. Example: an enrollment request in mid-March is effective April 1.

Switch Pathways

The 5-Star SEP can be used to switch:

  • From Original Medicare → 5-star MA plan or 5-star MA-PD plan
  • From one MA plan → 5-star MA plan or 5-star MA-PD plan
  • From one Part D PDP → 5-star Part D PDP
  • From MA-PD plan → Original Medicare + 5-star standalone Part D PDP (with Medigap if eligible)
  • From MA-only plan → 5-star MA-PD plan (gaining Part D coverage)

Coordination with Disenrollment

When switching to a 5-star plan via the 5-Star SEP:

  • The new 5-star plan handles disenrollment from the prior plan automatically
  • The beneficiary doesn't need to separately cancel the prior plan
  • Effective date is consistent (first of following month)
  • Brief overlap of coverage is reconciled by CMS

How the 5-Star SEP Coordinates with QBP

The 5-Star SEP and the Quality Bonus Payment Program are related but operationally distinct:

QBP Coordination Points:

  • Bonus magnitude is similar across higher-rated plans: 4-star-and-up plans share in the QBP bonus pool; the bonus percentages and any county-level adjustments are set in CMS rate guidance.
  • 5-Star SEP is unique to 5-star plans: 4-star and 4.5-star plans do not qualify.
  • Combined effect: A 5-star plan has both QBP economics AND the enrollment advantage of year-round 5-Star SEP eligibility.

Why Plans Pursue 5 Stars Beyond QBP:

Since higher-rated plans share QBP economics, plans pursuing 5 stars do so for:

  • 5-Star SEP enrollment growth
  • Member retention (5-star is a powerful marketing signal)
  • Brand reputation
  • Provider network leverage (top providers want to be associated with top plans)
  • Scale economies that compound with growth

For Georgia beneficiaries, the practical implication is that 5-star plans typically:

  • Participate in the same QBP bonus framework as other higher-rated plans
  • Have access to year-round 5-Star SEP enrollment
  • Tend to invest in quality at higher levels (to maintain 5-star status year-over-year)
  • May offer richer supplemental benefits (though this is not guaranteed)

5-Star SEP vs Other Special Enrollment Periods

The 5-Star SEP is one of many special enrollment periods. Key distinctions:

5-Star SEP:

  • Triggered by plan quality, not by a life event
  • Year-round window across the contract-year cycle
  • Once per cycle
  • Only into 5-star plans
  • All beneficiaries eligible if a 5-star plan is available

Life-Event SEPs (e.g., moving, losing employer coverage):

  • Triggered by a qualifying life event
  • Time-limited window from event date (typically a couple of months)
  • Generally one use per qualifying event
  • Can switch to any available plan
  • Eligibility depends on the specific life event

Continuous SEPs (e.g., Medicaid/Extra Help):

  • Triggered by status (dual eligibility, LIS)
  • Continuous availability (can be used multiple times per year, subject to frequency rules)
  • Restricted to certain plan types in some cases
  • Eligibility depends on status

LIS SEP for Extra Help recipients:

  • Available to LIS-eligible beneficiaries
  • Available multiple times per year, subject to CMS frequency limits, generally effective the first of the following month. Confirm current frequency rules with CMS guidance.

The 5-Star SEP is distinct because it is the only SEP based on plan attributes rather than beneficiary circumstances.

Georgia 5-Star SEP Year-Round Context

For Georgia specifically:

Georgia has a large Medicare beneficiary population statewide, with substantial enrollment in both Medicare Advantage and standalone Part D PDPs.

Major Georgia plans eligible for or pursuing 5-star status:

  • Humana
  • UnitedHealthcare
  • Aetna (CVS Health)
  • Anthem (Elevance Health)
  • Wellcare (Centene)
  • Cigna
  • Kaiser Permanente Georgia
  • Alignment Health Plan
  • Devoted Health (in some counties)

Each year, CMS releases new Star Ratings in October. Which specific Georgia plans achieve 5.0 stars varies year-to-year. Beneficiaries should check current-year status before assuming a plan is 5-Star SEP eligible.

Geographic considerations:

  • Atlanta metro (Fulton, DeKalb, Cobb, Gwinnett, Clayton, Cherokee) typically has more 5-star options
  • Rural Georgia counties (Worth, Crisp, Ben Hill, etc.) may have fewer or no 5-star plans available
  • Macon (Bibb), Augusta (Richmond), Savannah (Chatham), Columbus (Muscogee), Gainesville (Hall), varies by year

GeorgiaCares SHIP at 1-866-552-4464 provides free, unbiased counseling on:

  • Current-year 5-star plan availability in your county
  • 5-Star SEP eligibility verification
  • Plan comparison (quality + network + formulary + benefits)
  • Marketing fraud detection

Georgia Senior Medicare Patrol at 1-866-552-4464 addresses 5-Star SEP marketing fraud. Some marketers misrepresent Star Ratings, falsely claim 5-star status, or attempt to push beneficiaries into using SEPs they do not actually qualify for. Report violations to SMP.

14 Best Practices for Georgia Beneficiaries Using the 5-Star SEP

  1. Verify current-year 5-star status before assuming a plan is 5-Star SEP eligible. Use Medicare.gov Plan Finder or call GeorgiaCares SHIP at 1-866-552-4464.

  2. Check Star Ratings each October when CMS releases new ratings. A plan that is 5-star this year might drop a half-star next year.

  3. Do not rush: the 5-Star SEP is available year-round. Take time to evaluate the 5-star plan thoroughly before switching.

  4. Verify provider network: confirm your PCP, specialists, and preferred hospitals are in the 5-star plan's network before switching.

  5. Verify formulary coverage: confirm your medications are on the 5-star plan's formulary at acceptable tiers and copays.

  6. Check pharmacy access: confirm your preferred pharmacy is in the 5-star plan's network.

  7. Review the Summary of Benefits and Evidence of Coverage carefully before switching.

  8. Understand the switch pathway: clarify whether you're switching from Original Medicare to MA, from one MA plan to another, etc.

  9. Use GeorgiaCares SHIP at 1-866-552-4464 for free unbiased counseling before switching.

  10. Document the date of your 5-Star SEP use: the once-per-cycle limit applies.

  11. Do not be pressured by marketing claims: verify 5-star status independently. Report misleading claims to GA SMP at 1-866-552-4464.

  12. Consider total cost: premium, MOOP, expected drug copays, and supplemental benefit value, not just Star Rating.

  13. Verify the effective date: generally the first of the following month. Plan your transition timing accordingly.

  14. Do not use the 5-Star SEP just because you can: only switch if the 5-star plan genuinely serves your needs better than your current plan.

14 Common Issues Georgia Beneficiaries Face with the 5-Star SEP

  1. "I thought all 4+ star plans were 5-Star SEP eligible": No. Only 5.0-star plans qualify. 4.0 and 4.5 star plans do not qualify, even though they share in the QBP bonus pool.

  2. "The 5-star plan I want is not available in my county": The 5-Star SEP only works for plans serving your service area. Check Plan Finder by ZIP code.

  3. "I already used the 5-Star SEP this cycle": The once-per-cycle limit applies. You can use it again when the new contract-year window opens.

  4. "The plan was 5 stars when I signed up but dropped to 4.5": That is okay, you are enrolled. The 5-Star SEP eligibility check is at the time of enrollment, not after. But you may want to evaluate at next AEP.

  5. "A marketer claimed their plan is 5 stars but Plan Finder shows 4.5": Misleading claim. Verify independently and report to GA SMP at 1-866-552-4464.

  6. "My PCP is not in the 5-star plan's network": Trade-off decision. Sometimes switching PCPs is worth it; sometimes staying with the current plan is right.

  7. "My medication is not on the 5-star plan's formulary": Use Plan Finder's drug-plan comparison. You may need to use the exception/appeal process if you switch.

  8. "I'm in a rural Georgia county, no 5-star plan available": Some rural areas do not have 5-star plans. The 5-Star SEP does not help in this case. Consider AEP timing for plan changes.

  9. "Can I use the 5-Star SEP to switch back to Original Medicare?": Only if you are switching to Original Medicare + a 5-star standalone Part D PDP. If you just want Original Medicare without Part D, use MA OEP or AEP.

  10. "I'm new to Medicare, can I use the 5-Star SEP immediately?": Yes, if all eligibility requirements are met. But your IEP gives you broader choice initially.

  11. "The 5-star plan's premium is higher": Compare total cost, not just Star Rating. Sometimes a 4-star plan with lower total cost is better.

  12. "What about Medigap with 5-Star SEP?": Medigap is regulated separately. The 5-Star SEP itself does not create Medigap guaranteed-issue rights. If switching from MA to Original Medicare + 5-star Part D PDP, you may face medical underwriting on the Medigap side.

  13. "Can I use the 5-Star SEP during AEP?": AEP overlaps with the 5-Star SEP each year. You can use either pathway. AEP is typically the broader pathway for general plan switching.

  14. "My plan keeps marketing 5-Star SEP, is that allowed?": Plans must follow CMS MCMG. Some marketing is permitted; some claims are restricted. Report concerning claims to GA SMP.

Worked Examples

Example 1: Fulton 67 Margaret, Using the 5-Star SEP Mid-Year

Margaret, age 67, lives in Atlanta (Fulton County) and is enrolled in a 4-star MA plan. In June, she learns from a friend about a new 5-star MA plan in her area. The 5-star plan has stronger supplemental benefits, specifically the dental coverage she needs after starting major dental work.

Margaret calls GeorgiaCares SHIP at 1-866-552-4464. The counselor:

  • Verifies the plan's 5.0-star status (current contract year)
  • Confirms it serves Fulton County
  • Confirms Margaret hasn't used the 5-Star SEP this year
  • Reviews Margaret's PCP and medications against the 5-star plan's network and formulary
  • Confirms compatibility

Margaret enrolls in the 5-star plan effective July 1 using the 5-Star SEP. Her prior plan is disenrolled automatically. She's now on a 5-star plan with better dental coverage for her ongoing dental work.

Example 2: DeKalb 70 James, Comparing 5-Star SEP vs MA OEP Timing

James, age 70, lives in DeKalb County and is enrolled in a 4-star MA plan. In February, he is dissatisfied with his plan's network because his specialist is no longer in-network. He is evaluating switching options.

He has two pathways:

  • MA OEP (early in the year): Can switch from his MA plan to another MA plan or back to Original Medicare. Available now.
  • 5-Star SEP: If a 5-star plan is available in DeKalb County, can switch year-round.

James calls GeorgiaCares SHIP at 1-866-552-4464. The counselor explains:

  • MA OEP allows broader switching (to any MA plan)
  • 5-Star SEP is limited to 5-star plans only
  • 5-Star SEP does not count against MA OEP usage (separate mechanism)

James reviews available 5-star plans in DeKalb County. None of the 5-star plans include his specialist. He uses MA OEP instead to switch to a different 4.5-star plan that includes his specialist.

Example 3: Cobb 68 Robert, Moving Into Georgia + 5-Star SEP

Robert, age 68, just moved from Tennessee to Cobb County. He has a permanent change-of-residence SEP available (life-event SEP) and is shopping for plans.

In addition to the move-related SEP, Robert sees that a 5-star plan is available in Cobb County. The 5-star plan has the strongest supplemental benefits he's seen.

GeorgiaCares SHIP at 1-866-552-4464 explains:

  • The move-related SEP gives him broad plan choice
  • The 5-Star SEP is an alternative pathway specifically for 5-star plans
  • Using either SEP enrolls him into a Georgia plan
  • He should use whichever pathway gives him the best plan match

Robert uses the move-related SEP to enroll in the 5-star plan (rather than the 5-Star SEP), preserving his 5-Star SEP availability for use later in the year if needed.

Example 4: Worth County 72 Linda, Rural Beneficiary and 5-Star Plan Availability

Linda, age 72, lives in Worth County (rural South Georgia). She is enrolled in a 3.5-star MA plan and wishes she could switch to a 5-star plan.

Linda calls GeorgiaCares SHIP at 1-866-552-4464. The counselor checks current-year Star Ratings for plans serving Worth County:

  • No 5-star MA plans available in Worth County
  • Available MA plans rated below the 5-star threshold
  • A 5-star standalone Part D PDP is available in Worth County

Since no 5-star MA plan serves her county, Linda cannot use the 5-Star SEP for MA. The counselor explains:

  • A 5-star Part D PDP is available; Linda could switch to Original Medicare + Plan G Medigap (if able to underwrite) + 5-star Part D PDP
  • This would be a different structure than her current MA plan
  • Trade-offs include cost, network, and benefit structure

Linda decides to stay with her current MA plan and re-evaluate at next AEP.

Example 5: Bibb 69 David, Switching from Original Medicare to 5-Star MA

David, age 69, lives in Macon (Bibb County) and is on Original Medicare + Plan G Medigap + standalone Part D PDP. He has been considering MA for the supplemental benefits but has not switched. In April, he reads about a 5-star MA plan serving Bibb County with extensive dental, vision, hearing, and transportation benefits.

David calls GeorgiaCares SHIP at 1-866-552-4464. The counselor:

  • Verifies the plan's 5.0-star status
  • Confirms David's PCP and specialists are in-network
  • Confirms his medications are on the formulary at acceptable cost-sharing
  • Walks through the trade-offs (network breadth, prior authorization patterns, MOOP)
  • Explains that switching to MA means his Medigap is no longer needed (and he should formally cancel)

David decides to switch. He uses the 5-Star SEP to enroll in the 5-star MA plan effective May 1. He cancels his Medigap and PDP. He notifies SSA of the change. He retains his Original Medicare entitlement (Parts A/B); the MA plan administers his benefits through a private plan structure.

Example 6: Hall 65 Sarah, First-Year-Medicare 5-Star SEP Usage

Sarah, age 65, enrolled in Medicare during her IEP in March of this year, selecting a 4-star MA-PD plan. In August, a 5-star MA-PD plan becomes available in Hall County (she sees the marketing).

Sarah calls GeorgiaCares SHIP at 1-866-552-4464. The counselor:

  • Verifies the new plan's 5.0-star status
  • Confirms it serves Hall County
  • Confirms Sarah hasn't used the 5-Star SEP this year
  • Reviews Sarah's healthcare needs against the 5-star plan
  • Recommends Sarah verify network and formulary independently

Sarah independently confirms her PCP and medications. The 5-star plan is a good fit. She uses the 5-Star SEP to switch effective September 1. The prior 4-star plan is disenrolled automatically.

Frequently Asked Questions

The federal SEP that allows Medicare beneficiaries to enroll in a Medicare Advantage plan, MA-PD plan, or standalone Part D PDP rated 5 stars, once per contract-year cycle outside the standard AEP and MA OEP windows. Authority lives in the Social Security Act and CMS's Medicare Advantage and Part D enrollment regulations.

Essentially year-round across the contract-year cycle, outside the brief AEP overlap. Verify the exact window dates on Medicare.gov.

Once per contract-year cycle.

Only plans rated at the top of the Star Ratings scale (5.0 stars) at the time of enrollment. Lower-rated plans (including 4.5-star plans) do not qualify.

Generally the first of the following month after your enrollment request.

A few more common questions:

When are Star Ratings released? Annually in October, for the following contract year.

How do I know if a plan is 5 stars in my county? Use Medicare.gov Plan Finder (filters by Star Rating) or call GeorgiaCares SHIP at 1-866-552-4464.

Can I use the 5-Star SEP during AEP? Yes, the windows overlap each year. But AEP is broader and typically the better pathway for general plan switching.

Can I use the 5-Star SEP to switch to Original Medicare? Only if switching to Original Medicare + a 5-star standalone Part D PDP. If you just want Original Medicare without Part D, use MA OEP or AEP.

Can I use the 5-Star SEP to switch from one Part D PDP to another? Yes, if the receiving Part D PDP is rated 5 stars.

What if my current plan is 5 stars and another plan becomes 5 stars, can I switch between them? Yes, using the 5-Star SEP, once per cycle.

Does the 5-Star SEP affect my Medigap? Not directly. But if you are switching from MA to Original Medicare + 5-star Part D PDP, you will need separate Medigap consideration. Medigap does not have guaranteed-issue rights linked to the 5-Star SEP.

What is the difference between 4.5 stars and 5 stars for SEP purposes? 4.5 stars do not qualify; 5 stars do. The half-star gap matters significantly.

What if a plan's rating drops mid-year? Star Ratings do not change mid-contract-year. The October release determines ratings for the following contract year.

What if I move to a county where my 5-star plan is not available? The move triggers a move-related SEP. The 5-star plan would need to be available in your new county for the 5-Star SEP to apply there.

Does the 5-Star SEP work for SNPs (Special Needs Plans)? Yes, if the SNP is rated 5 stars. SNPs also have their own enrollment frameworks (continuous SEPs for D-SNPs, etc.).

Can I use the 5-Star SEP if I'm in a SNP? Yes, if you are eligible for the receiving 5-star plan. But evaluate carefully because leaving a SNP might mean losing specialized benefits.

How does the 5-Star SEP coordinate with QBP? Higher-rated plans share in the QBP bonus pool; the 5-Star SEP is an additional enrollment advantage unique to 5-star plans.

Why do plans pursue 5 stars if QBP is similar for other higher-rated plans? For the 5-Star SEP enrollment advantage, marketing reputation, member retention, and provider network leverage.

Are 5-star plans always the best choice? Not necessarily. Star Rating is one input among many. Always evaluate network, formulary, pharmacy access, MOOP, premium, and total cost.

How do I report misleading 5-Star SEP marketing? Call Georgia Senior Medicare Patrol at 1-866-552-4464.

Can I use multiple SEPs in one year? Yes, different SEPs serve different triggers. The 5-Star SEP is one tool among many. Some SEPs have separate use limits.

Does the 5-Star SEP create guaranteed-issue Medigap rights? No. Medigap guaranteed-issue rights are governed by separate federal and state rules. The 5-Star SEP itself does not trigger them.

What if I use the 5-Star SEP and regret the switch? You would need a separate enrollment opportunity to switch back, either AEP, MA OEP (if eligible), another SEP trigger, or wait for the next 5-Star SEP cycle.

How does the 5-Star SEP relate to LIS SEP? They are different SEPs. The LIS SEP is available to Extra Help recipients and can be used more frequently throughout the year, subject to CMS frequency rules. The 5-Star SEP is available to all beneficiaries (once per cycle). They can coexist.

Where can I learn more about the 5-Star SEP in Georgia? GeorgiaCares SHIP at 1-866-552-4464 provides free counseling. Medicare.gov has consumer-friendly explanations.

What if I miss the 5-Star SEP window? The window is essentially year-round, so it is hard to miss. But if you have already used your once-per-cycle SEP and want to switch again, you would need AEP, MA OEP, or another qualifying SEP.

CTA: Phone Numbers and Resources

  • Medicare 1-800-MEDICARE (1-800-633-4227), federal Medicare hotline
  • Social Security Administration Medicare Enrollment 1-800-772-1213
  • GeorgiaCares SHIP 1-866-552-4464, free 5-Star SEP counseling
  • Georgia Senior Medicare Patrol 1-866-552-4464, 5-Star SEP marketing fraud detection
  • Medicare Rights Center 1-800-333-4114, national Medicare advocacy
  • Georgia Department of Community Health Member Services 1-866-211-0950
  • Atlanta Legal Aid 404-377-0701, free legal services for Atlanta metro seniors
  • Georgia Legal Services 1-800-498-9469, free legal services outside Atlanta
  • Eldercare Locator 1-800-677-1116, connects to Georgia AAAs
  • 211 Georgia: community resource referrals
  • Patient Advocate Foundation 1-800-532-5274, case management for serious illness
  • Humana Medicare 1-800-457-4708
  • UnitedHealthcare Medicare 1-800-721-0627
  • Aetna Medicare 1-800-282-5366
  • Anthem Medicare 1-833-919-1577
  • Wellcare 1-833-444-9088
  • Cigna Medicare 1-800-668-3813
  • Kaiser Permanente Georgia 1-888-865-5813

This guide is for educational purposes and does not constitute legal, financial, or medical advice. Consult licensed professionals and CMS resources for personalized guidance.

Find personalized help navigating Medicare enrollment and the 5-Star SEP at brevy.com.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.