Bar Keeps Rising For Medicare Advantage Star Ratings

While still murky, the Medicare Advantage waters are clearing up. As we detailed in earlier posts, insurers pulled back from certain markets in 2025 and made significant changes to benefits, all of which means members will have to make tough tradeoffs as they comparison shop. And insurers need to keep a close eye on their competitors and consumer behavior as they refine product portfolios for the future.

It’s also important to assess the impact that more stringent Medicare Advantage Star ratings are having on the industry. Significant fallout is occurring with multiple insurers suing the Centers for Medicare and Medicaid Services over the agency’s methodology and resulting ratings.

Our analysis of 2025 Star ratings unearthed some compelling findings:

• The share of 4+ Star contracts dropped to 40% of all contracts in Stars Year (SY) 2025. This is the lowest number of in-bonus contracts over the last five-plus years.
• The share of 5-Star contracts dropped to just 1% of all contracts in SY2025, compared to 6% in SY2024. Only seven contracts received a 5-Star rating.
• The percentage of Medicare Advantage members in bonus earning contracts, based on October 2024 enrollments, dropped to 63% for SY2025, down from a high of 89% in SY2022.

Blues and Provider-owned plans catching up to national insurers

While the three largest national health insurers — Aetna, Humana, and UnitedHealthcare — have historically performed stronger in Stars, a drop in their performance for 2025 resulted in more parity with provider-owned and Blue Cross Blue Shield contracts.

In fact, 89% of members in provider-owned plans were in 4+ Star products, compared to 61% for the three large national carriers. And that’s down from 2024 when 85% of members for the big three were in 4+ Star plans. The change is due in large part to both UnitedHealthcare and Humana losing bonus eligibility on contracts that cover 15% and 70% of their members respectively.

It’s worth noting that while a rebound in Kaiser Permanente’s performance for SY2025 influenced the provider-owned numbers, non-Kaiser provider-owned contracts still had 80% of membership in 4-Star+ plans.

Dual-eligible special needs plans struggle

The bar has risen for dual-eligible special needs plans (D-SNP), which typically lag non-SNP plans due to a population that’s harder to manage. In contracts with a high share of D-SNP membership — 75% or more — only 36% of members were enrolled in 4+ Star contracts, down from 65% in SY2024. Some relief may come for D-SNPs when a new Health Equity Index Reward Factor takes hold for SY2027, but it remains to be seen the extent to which they will continue to have lower rates of bonus-earning membership.

Plans adjust to new weights for health and drug domains

Star ratings, particularly for high-performing contracts, were buoyed by CAHPS and administrative/operational measures like those for reviewing and making timely decisions around appeals. Combined, CAHPS and administrative/operational measures currently make up roughly 60% of Stars score.

Changes underway for SY2026 will increase the relative importance of such areas as HEDIS, the health outcome survey, and Part D measures like medication adherence. CAHPS, appeals, and other areas will decrease in their weighted importance to roughly 40% of the Stars score . These shifts will put pressure on plans to recalibrate their efforts in different domain areas to ensure strong overall performance for upcoming Stars years. The magnitude of the jumps seen in HEDIS cut points in SY2025 results only intensifies this pressure. It will be interesting to see what happens to the slate of bonus-earning contracts in SY2026.

How will the stars align in the future?

The bar for Stars will continue to be high and likely will keep rising. Medicare Advantage plans must be diligent in monitoring performance and consumer behaviors, tracking regulatory changes, and executing on initiatives to manage and improve their Stars performance.