Medicare Advantage star ratings decline: 5 things to know

https://www.beckerspayer.com/payer/medicare-advantage-star-ratings-decline-5-things-to-know.html

Average Medicare Advantage star ratings declined for the third year in a row, according to CMS data published Oct. 10. 

The average Medicare Advantage star rating for 2025 is 3.92, down from 4.07 in 2024. 

Plans must earn a rating of 4 or higher to receive bonus payments from CMS. 2025 star ratings affect the quality bonus payments plans receive in 2026. 

Here are five things to know about the star ratings: 

1. Just seven plans received a five-star rating in 2025, down from 38 in 2024.
2. Around 40% of Medicare Advantage-Part D plans received four stars or higher. Around 62% of MA-PD enrollees are in plans rating four or higher, according to CMS.
3. CMS did not make any major changes in star ratings methodology, according to the release.
4. Medicare Advantage-Part D plans are rated on 40 clinical quality and member service measures. CMS determines cut points for measure each year. For 2025, many cut points increased, meaning plans had to perform better to get higher star ratings.
5. Several factors influenced the tougher cut points, CMS said. The agency removed extreme outliers from the lower end of performance, a more compressed distribution on scores and an increasing number of high-scoring contracts. Some measures are improving to pre-pandemic levels, increasing cut points, CMS said.

Potential challenges to CMS’ star ratings could loom. Earlier in October, Humana said its star ratings for 2025 dropped significantly from 2024. In 2025, just 25% of its members will be in contracts rated plans four stars and above, down from 94% in 2024. The company said it expected the drop was driven by “narrowly missing industry cut points on a small number of measures.” In regulatory filings, the company said it believes there may be potential errors in CMS’ calculations. 

UnitedHealthcare is also challenging CMS’ star ratings. The company filed a lawsuit Sept. 30, challenging CMS’ inclusion of a secret shopper phone call in its star ratings that UnitedHealthcare said never connected. 

In June, CMS recalculated 2024 star ratings for all Medicare Advantage plans. Judges sided with SCAN Health Plan and Elevance Health in lawsuits challenging the methodology CMS used to calculate the ratings. 

In addition to determining bonus payments, star ratings guide beneficiaries’ decisions on which plan to enroll in. Open enrollment begins Oct. 15 and runs until Dec. 7.

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