Medicare 5-Star SEP: How the Once-a-Year Switch Works

The Medicare 5-star Special Enrollment Period (SEP) lets you switch into a Medicare Advantage plan, Medicare Cost Plan or stand-alone drug plan that has an overall 5-star rating, once, at almost any point in a nearly year-long window. You don’t need a move, a job change or any other life event. You need a 5-star plan available where you live, and you need to check what you’d give up by leaving your current coverage.

It is a useful rule, and an easy one to misuse. Below we explain who qualifies, the dates, how to enroll, what happens to your old plan, and why it has nothing to do with Oregon’s Medigap birthday rule.

TL;DR

• The 5-star SEP is a one-time switch into an available plan with an overall 5-star rating. It runs from December 8 through November 30 of the following year.
• It applies to Medicare Advantage plans, Medicare Cost Plans and stand-alone Part D drug plans. It does not require a qualifying life event.
• Coverage starts the first day of the month after your request is received, and your old plan is dropped automatically.
• Moving from a plan with drug coverage to a 5-star plan without it can leave you without drug coverage and open to a Part D late enrollment penalty.
• It does not change Medigap rules. Oregon’s birthday rule is a separate right that works on your birthday window.

Table of Contents

• What the 5-star SEP is
• How it differs from other enrollment periods
• Who can use it and what you can switch into
• When you can use it and when coverage starts
• How to check whether a 5-star plan is available in Bend
• How to enroll and what happens to your current plan
• The 5-star SEP is not the Oregon Medigap birthday rule
• Should you use it?
• Our perspective
• Get a second set of eyes before you switch
• FAQ
• Sources

What the 5-star SEP is

Medicare describes the 5-star SEP as a one-time opportunity to enroll in an available plan with an overall 5-star rating, and the window runs from December 8 through November 30 of the following year. The plan types covered are Medicare Advantage plans, Medicare Cost Plans and Medicare prescription drug plans.

If you read the dates literally, you will notice the window is not a calendar year. It opens on December 8, the day after Annual Enrollment ends, and closes on November 30 of the next year. That means one window covers essentially the whole plan year, and it overlaps the following Annual Enrollment Period only in the sense that it ends just before the next one starts on October 15 and goes to December 7.

The rating itself comes from Medicare. CMS says it builds the overall performance ratings from member satisfaction surveys, plan data and information from health care providers, and treats five stars as excellent. Ratings are updated each year, so a plan that earned five stars one year isn’t guaranteed to hold them the next.

How it differs from other enrollment periods

Medicare has several windows, and each one answers a different question. Here is how they compare.

Medicare’s own enrollment periods guide makes the key distinction: the 5-star SEP is tied to plan quality and local availability, while other SEPs depend on an event, and their length and allowed changes vary with that event.

For a wider tour of the calendar, see our guide to Medicare enrollment periods and our overview of special enrollment.

Who can use it and what you can switch into

If a 5-star Medicare Advantage plan, Cost Plan or drug plan is available where you live, you can use the 5-star SEP to move into it from your current plan. Three points deserve attention.

The plan has to be available to you. Plans are sold by service area. A 5-star plan in another state or in a different county doesn’t help a Deschutes County resident. Availability, not just the rating, decides whether the SEP is useful.

Cost Plans count. CMS guidance for contract year 2026 says people in a Medicare Advantage or drug plan can leave it for an open Cost Plan with a 5-star rating using this SEP.

Drug coverage may need a second step. The same CMS guidance says people who join certain 5-star plans without drug coverage may qualify for a coordinating SEP to pick a stand-alone Part D plan. Don’t assume that applies to you. Confirm it with the plan before you enroll.

What it does not cover

The 5-star SEP is about Medicare Advantage, Cost Plans and drug plans. It is not a way to sign up for Medigap, and it doesn’t give you guaranteed acceptance on a Medigap policy. If you have Original Medicare with a supplement and want to move to Advantage, you should think hard about what you’re leaving behind, which we cover below.

When you can use it and when coverage starts

CMS guidance for contract year 2026 says the SEP can be used once, from December 8 of the year before the plan year through November 30 of the plan year, as long as the plan keeps its 5-star rating. Coverage begins on the first day of the month after the plan receives your request.

That timing leads to a few practical rules:

• Once means once. Use it and the SEP is spent for that plan year. You don’t get a second try if the new plan disappoints you.
• Request early in the month to be clear. Because coverage starts the first of the next month, a request on the 3rd and a request on the 28th both start on the same day. There’s no benefit to rushing at the end of a month, and no penalty for asking early.
• The window ends in late fall. If you’re reading this in the fall, the current window closes on November 30. The next one opens December 8. Check Medicare’s site for the current rating year rather than relying on last year’s list.

How to check whether a 5-star plan is available in Bend

The official tool is the Medicare Plan Finder at Medicare.gov/plan-compare. It shows the overall plan rating, and CMS training material notes that ratings are updated annually, so you want the rating for the current or upcoming plan year. Medicare’s yearly review booklet adds that the Plan Finder lets you compare plans side by side, see quality and customer service ratings, and search for providers in plan networks.

A simple routine for Central Oregon:

1. Enter your ZIP code (Bend is 97701, 97702, 97703 and 97707, for example) and choose your current drugs and pharmacies.
2. Filter or sort by overall star rating and look for plans showing 5 stars.
3. For each, check your doctors and hospital in the network. This matters in a region where specialists may be a drive away.
4. Compare the drug list, out-of-pocket maximum and monthly premium to what you have now.
5. Confirm the rating applies to the plan year you will actually be in.

If no 5-star plan appears for your ZIP code, the SEP is simply not available to you that year. That is common in smaller markets. Our write-up on the 2026 to 2027 star ratings explains how to read the ratings.

How to enroll and what happens to your current plan

You request enrollment in the 5-star plan. Per CMS guidance, that request automatically disenrolls you from your previous plan, so you don’t have to cancel the old plan yourself. Please don’t cancel first. If you drop your plan and the new enrollment doesn’t go through, you could be left without coverage.

Before you submit, run through this list:

• Your doctors, clinics and preferred hospital are in the new plan’s network.
• Every prescription you take is covered, and you know the tier and cost.
• You know the new plan’s premium, deductible and annual out-of-pocket limit.
• You have a start date in mind: the first of the month after the request.

The drug coverage trap

This is the part many people miss. Medicare warns that if you move from a Medicare Advantage plan with drug coverage into a 5-star plan without it, you may lose your prescription drug coverage and could owe a Part D late enrollment penalty. Before enrolling, ask directly whether the plan includes Part D. If it doesn’t, ask about the coordinating SEP for a stand-alone drug plan, and get the answer before you sign.

For background on drug plan costs, read our piece on the Part D deductible.

The 5-star SEP is not the Oregon Medigap birthday rule

Many Oregon readers mix these up, because both let you change coverage outside the fall window. They work on different coverage and different triggers.

The state’s own birthday rule fact sheet says a current Medigap policyholder can apply during the period starting 30 days before and ending 30 days after their birthday, and get a guaranteed change to the same plan type or one with fewer benefits, regardless of health. The sheet describes it as a chance to compare prices and switch companies while keeping the same plan type or choosing a lesser one.

So if you pay for a Medigap Plan G and your premium has crept up, the 5-star SEP is not your tool. Your birthday window is. If you are weighing it, our page on Medicare Supplement plans explains the options.

Should you use it?

A 5-star rating is a signal about plan quality: member satisfaction, how the plan performs and how it serves its members. It is not a promise that the plan is the best fit for you. Plenty of people are better served by a 4-star plan that includes their cardiologist than by a 5-star plan that doesn’t.

The SEP makes the most sense when:

• Your current plan has had service problems, denials or network changes that hurt you.
• A 5-star plan covers your doctors and your drugs at a similar or lower total cost.
• You already have an Advantage or drug plan, and the switch keeps your drug coverage intact.

It makes the least sense when:

• You have a Medigap policy and would be moving to Advantage for a lower premium. Going back to Medigap later can mean medical underwriting in many cases, and a plan that holds five stars this year may not next year.
• Your doctors are outside the new network.
• You’ve already used the SEP this plan year.

If you are unsure, a second opinion costs nothing. Our guide on leaving Medicare Advantage in Central Oregon covers the one-change rules that apply elsewhere in the year.

Our perspective

We talk with Central Oregon residents about plan changes every year, and the 5-star SEP is a good example of a rule that sounds simpler than it is. The star number is easy to love. The network, the drug list and the plan’s rules about referrals are where people’s real experience of a plan comes from.

Our approach is education first. We would rather you walk away understanding why a plan does or doesn’t suit you than enroll on a hunch. That means we start with your doctors and your prescriptions, then look at the rating, not the other way around. We also tell people when the best move is no move: staying put, using your Medigap birthday window, or waiting for Annual Enrollment.

Because we work locally, we know that availability here differs from what national advertising suggests. A plan promoted on television may not be offered in Deschutes County at all. So we check what is actually on offer in your ZIP code before we talk about whether it’s worth switching.

— Jesse Zimmerman

Get a second set of eyes before you switch

If you are weighing a switch, we offer free consultations, in person in Bend or remotely, to walk through your options without sales pressure. We can help you check availability, confirm your doctors and drugs, and make sure you don’t give up drug coverage by accident. See our Medicare Enrollment Assistance service, or book an annual plan review to look at where you stand every year.

For free, unbiased help, you can also call 1-800-MEDICARE (1-800-633-4227) or contact your State Health Insurance Assistance Program (SHIP). Medicare’s yearly review booklet lists both as sources of personalized assistance. Our post on free Medicare advice explains where each kind of help fits.

FAQ

Can I use the 5-star SEP more than once?

No. It can be used once during the window, which runs from December 8 through November 30 of the following year. After you use it, you will need another window, such as Annual Enrollment, to change again.

Do I need a qualifying life event?

No. Event-based SEPs depend on things like a move or the loss of employer coverage. The 5-star SEP depends on a 5-star plan being available in your area, not on anything that happened to you.

When does my new coverage start?

Coverage starts on the first day of the month after the plan receives your request. Your previous plan ends automatically when the new enrollment takes effect, so you shouldn’t cancel it yourself.

Can I use it to change my Medigap policy?

No. The 5-star SEP covers Medicare Advantage, Cost Plans and drug plans. In Oregon, Medigap changes follow the birthday rule, which gives you a window from 30 days before to 30 days after your birthday to switch to the same plan type or one with fewer benefits.

Will I lose my prescription coverage?

You can, if you leave a plan with drug coverage for a 5-star plan that has none. That may also expose you to a Part D late enrollment penalty, so confirm drug coverage before you enroll.

Sources

• Special Enrollment Periods, Medicare.gov
• Understanding Medicare Advantage and Medicare Drug Plan Enrollment Periods, Medicare.gov
• Cost Plan Enrollment and Disenrollment Guidance, CY 2026, CMS
• Understanding Medicare workbook, CMS
• 5-Star Plan Ratings overview, CMS
• Your Yearly Medicare Review, Medicare.gov
• Medigap birthday rule fact sheet, Oregon DFR

Recommended

• Medicare Special Enrollment: What Eligible Adults Need to Know
• Medicare Enrollment Periods You Need to Know for 2026
• 2026–2027 Medicare Star Ratings: What U.S. Beneficiaries Must Know
• Medicare AEP 2026: Key Dates, Rules, and What’s New

Disclaimer: This article is for general educational purposes only and does not constitute personalized advice. Medicare rules and plan details change frequently.