Star ratings, which measure quality, customer service, and the member experience, are critical to determine a health plan’s performance, bonus payments and rebates, and are key to enrollment and retention. CMS recently published its 2025 Medicare Advantage and Part D Star Ratings fact sheet.
Here, we explore some of our key takeaways, how they will impact your plan, plus, how you can boost your Star ratings in 2026.
Medicare Advantage Plans Are Under-Performing
CMS’ most recent findings echo trends we’ve seen for quite some time.
- Approximately 40% of plans that will be offered in 2025 earned 4 or more stars for their 2025 overall rating—down approximately 10% from 2024.
- Weighted by enrollment, 62% beneficiaries are currently in contracts that will have 4 or more stars in 2025 compared with about 74% last year.
CMS found that overall Star ratings have dropped significantly over the past 3 years. In 2022:
- 152 plans achieved 4 stars or higher, while just 116 plans could say the same for 2025.
- 74 plans received 5 stars, which dropped to just 7 in 2025.
CMS also identified 8 contracts that are consistently low-performing plans—up from 6 contracts last year.
Plans that achieve 4 stars or higher are awarded a 5% quality bonus payment. Plans can use the additional payments to cover the cost of supplement benefits, including reduced cost sharing, extra benefits not covered by traditional Medicare, and lowering Part B and/or Part D premiums.
CMS noted that changes in Star Ratings year-over-year are normal, expected, and vary by measure. They also stated that cut points are recalculated each year based on performance during the measurement period, and many cut points increased from 2024, meaning that plans had to achieve higher performance on the measures to receive a high Star Rating.
Star Ratings By Measure Are Also Declining
The recent data also showed that plans experienced poor performance on certain measures. An increasing number of plans scored highly on some measures such as breast cancer, while others scored lower on measures such as colorectal cancer screenings. Other performance measures such as controlling blood pressure, medication adherence, and diabetes care declined as well.
Minor Calculation Changes
While there were no major methodological changes in the 2025 Star Ratings, there were minor changes to calculations.
For example, the weighting for All-Cause Readmissions increased from 1x to 3x.
CMS also added the Tukey outlier deletion to non-CAHPS measures. The outlier deletion is meant to improve accuracy and stability of the Star Ratings measure-level cut points, they noted. CMS projected this would save $935 million in 2025, and $1.5 billion by 2030, a report by Milliman found.
How To Improve Your Plan's Performance
As you look ahead to 2026, identifying new ways to manage your costliest members, improve quality, outcomes, and the member experience, and boost your Star ratings will be top of mind.
Digital health solutions that are easy-to-implement, integrated, and scalable and offer tailored care programs, a high-touch clinical care team, and effective member engagement strategies will be the key to drive optimal outcomes and a ROI.
Learn more about how to evaluate potential vendors with our “Buyer’s Guide to Digital Health Solutions for Chronic Care Management.” Download now.
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