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The 5-Star Special Enrollment Period: Kaiser Permanente Washington Medicare Advantage (HMO) plans are rated 5 out of 5 stars for 20221

Do you have Medicare clients unhappy with their existing coverage? Or maybe they’re looking for more coverage. Keep in mind that Kaiser Permanente Washington Medicare Advantage (HMO) health plans are rated 5 out of 5 Stars for the 2022 plan year.

Here's a Q&A refresher on the 5-Star special enrollment period (SEP) and what it means for you and your clients:

When can the 5-Star SEP be used?

One time between December 8 and November 30. The effective date will be the 1st of the month following receipt of the enrollment request.

Who is eligible to use the 5‑Star SEP?

A Medicare beneficiary must meet 3 requirements to use the 5‑Star SEP:

  1. Must be enrolled in Medicare Part A & Part B
  2. Must have a 5‑Star plan available in their service area
  3. Must not have already used the 5‑Star SEP to make an election for the applicable plan year

What can eligible beneficiaries do with the 5‑Star SEP?

Beneficiaries with various types of coverage can enroll/switch to a 5‑Star Medicare Advantage (MA)/Medicare Advantage Prescription Drug plan (MAPD). Examples of allowable coverage changes using the 5‑Star SEP:

  • Original Medicare only beneficiaries can enroll in a 5‑Star MA/MAPD plan
  • Original Medicare + PDP beneficiaries can change to 5‑Star MA/MAPD plan
  • Medicare Supplement (Medigap) beneficiaries can change to a 5‑Star MA/MAPD plan
  • Non 5-Star MA/MAPD members can change to a 5‑Star MA/MAPD plan
  • 5-Star MA/MAPD members can change to another 5‑Star MA/MAPD plan

Can existing Kaiser Permanente Medicare Advantage members use the 5‑Star SEP to add on the optional Delta Dental supplement benefit (OSB) dental plan/rider?

No, the 5-Star SEP cannot be used to only add dental. If the beneficiary is using the 5‑Star SEP to enroll in or switch into a Medicare Advantage (MA) plan, they can add dental at the time of enrollment or within 30 days of the new MA plan effective date.

If the beneficiary is already enrolled in a Kaiser Permanente individual Medicare Advantage plan and not wanting to make an MA plan change, dental enrollment periods should be reviewed. For example: Is the request within 30 days of their MA plan effective date? Was the request received during the dental open enrollment period (Oct. 15 through Jan. 31)?

What enrollment period on the Kaiser Permanente enrollment/election form should the beneficiary select to use the 5‑Star SEP?

Since the 5-Star SEP option is not included on the online and paper CMS model enrollment forms that Kaiser Permanente uses, beneficiaries wanting to use the 5‑Star SEP can bypass the "Attestation of Eligibility" selection page without selecting an option. The enrollment will default to the 5‑Star SEP unless another election period SEP takes precedence (example: MA OEP, ICEP etc.), or if the beneficiary has already used their one time per year 5‑Star SEP election.

Have more questions?

See our 5 Star SEP FAQ (PDF), or reach out to our Medicare Sales Producer Support team, Monday through Friday, at 1‑800‑581‑8252 or KPWA.Medicare@kp.org.
 
1Every year, Medicare evaluates plans based on a 5‑star rating system. Star ratings are awarded each year by the Centers for Medicare & Medicaid Services (CMS). CMS evaluates health plans based on several factors, such as member complaints, how many people leave a plan, drug prices, and more.
 

All plans offered and underwritten by Kaiser Foundation Health Plan of Washington or Kaiser Foundation Health Plan of Washington Options, Inc.

©2022 Kaiser Foundation Health Plan of Washington