A Medicare Advantage or Part D plan that scores below three stars in Medicare’s quality ratings for three consecutive years loses the leverage that normally keeps members locked into their coverage until the next enrollment season. Anyone enrolled in a plan carrying that low-performing designation can leave for a different Medicare Advantage or drug plan any time the designation stands, with no calendar window to track and no deadline to miss. That stands in sharp contrast to the reward version of the same ratings system: a member chasing a five-star plan gets exactly one chance a year, boxed into the same December-to-November stretch as ordinary enrollment changes.
Three Straight Years Below Three Stars Removes the Calendar Entirely
Medicare assigns every Medicare Advantage and Part D plan an overall star rating from one to five each year, built from measures that include member complaints, customer service responsiveness and how well a plan manages chronic conditions. A plan that lands under three stars for three consecutive annual ratings is flagged as a low performer, a designation CMS attaches to the contract itself rather than to any individual member, which means everyone enrolled under that contract inherits the identical exit right regardless of how long they have personally been signed up.
That exit right is unusually open-ended under Medicare’s special enrollment period rules: a member can switch to a different Medicare Advantage or Part D plan any time they remain in the low-performing plan, not just during a fixed window tied to a notice date. The right lasts exactly as long as the low-performing label does, which means it can disappear if the plan’s rating later climbs back above the threshold, turning what looks like a standing escape hatch into a right tied to the plan’s next rating cycle.
Outside a small set of special enrollment periods like this one, most Medicare Advantage and Part D members can only change coverage during the annual Open Enrollment Period that runs October 15 through December 7, or during the narrower Medicare Advantage Open Enrollment Period each January through March that permits one additional switch. The low-performer exit ignores both of those windows entirely, which is what separates it from nearly every other change a member can make outside of moving, losing other coverage or one of the handful of life events Medicare separately recognizes.
Free plan-change checklist: A Medicare plan can change its costs, drugs and doctors for next year even when its name stays the same. Check the changes with the free 2027 review sheet.
The Once-a-Year Trade in the Opposite Direction
Medicare offers a separate special enrollment period for members moving toward a five-star plan rather than away from a failing one, and the terms are far narrower. That switch can be used only once between December 8 of one year and November 30 of the next, so a member who uses it in January to reach a five-star plan cannot use it again later in the same cycle even if a better-rated option opens up nearby in the months that follow.
The five-star move also carries a coverage trap the low-performer exit does not share: a member leaving a Medicare Advantage plan that includes drug coverage for a stand-alone five-star Part D plan is disenrolled from the health portion of the old plan entirely and reverts to Original Medicare for medical care, not just for drugs, an outcome that typically calls for a Medicare Supplement policy to cover what Original Medicare does not. A member moving from a Medicare Advantage plan with drug coverage to a five-star Medicare Advantage plan without it can lose prescription coverage outright until the next enrollment opportunity, plus exposure to a Part D late enrollment penalty for the gap in between.
Judging a Plan by Its Rating Alone Misses What Changes Underneath It
Star ratings are published on Medicare’s Plan Finder tool on an annual cycle, which means the number attached to a plan in September reflects performance measured during an earlier period rather than the plan’s current drug formulary or provider contracts. A plan can carry the same three-star rating for a second or third straight year while its network of doctors or its list of covered drugs changes meaningfully from one plan year to the next, changes the rating itself does not capture.
That gap matters most for a member using the low-performer exit specifically to fix a service problem, since switching plans to escape poor customer service or care coordination should come with a check of whether a receiving plan’s provider network actually includes that member’s current doctors and hospitals, rather than an assumption that a higher star count alone guarantees continuity of care.
The two special enrollment periods sit at opposite ends of the same ratings system for a related reason: Medicare leaves the low-performer exit open indefinitely because the designation exists specifically to let members leave a contract the government has already flagged as underperforming for three straight years, while it rations the five-star switch to once annually because moving toward a five-star plan is a voluntary upgrade rather than an exit from a flagged contract.
That asymmetry leaves a member with more control than the enrollment calendar suggests once a plan’s rating starts slipping: renewing coverage during a fall Open Enrollment Period does not lock anyone into a contract that spends a third consecutive year under three stars, and the same rule that lets Medicare flag a plan as low-performing is the rule that hands its members the right to leave before the next rating cycle even arrives.
Judging a Plan on Stars, Drugs and Doctors
The rating gap described above is exactly the blind spot a plan comparison has to close: a rating attached to last year’s performance says nothing about a plan’s current drug list or which doctors still take it this plan year. Anyone using either the low-performer exit or the once-a-year five-star switch is choosing a replacement plan without that context unless it is checked directly.
The 2027 Medicare Open Enrollment Decision Kit is a 42-page decision kit with a prescription-by-plan comparison and the Open Enrollment calendar, alongside a cost calculator spreadsheet that scores plans on cost, drugs and doctors.
Compare drug coverage and cost using the prescription-by-plan comparison in The 2027 Medicare Open Enrollment Decision Kit.
This article was researched and drafted with the assistance of AI and reviewed by The Money Overview editorial team.
