By Healthcare Brew Staff
less than 3 min read
Definition:
Medicare Advantage (MA) star ratings are overseen by the Centers for Medicare and Medicaid Services (CMS). These ratings grade MA contracts based on 38 quality and performance metrics, like care coordination and how well a plan’s call center works. Top performers that get a four- or five-star rating receive bonus payments, which can help plans enroll more members and increase insurer profits.
Star ratings aim to improve the quality of care and Medicare beneficiaries’ overall health by holding providers and facilities accountable for the care they provide.
How did the Covid-19 pandemic impact these ratings?
In late 2023, insurers experienced low post-pandemic ratings after CMS ended “disaster” provisions, leading to two lawsuits that questioned CMS’s decision-making process. The agency announced last June it would recalculate its star ratings for 2025.
How have payers responded to the lower star ratings?
Many insurers sued CMS over their low 2025 star ratings—they were mostly due to call center performance—which they claimed hurt profits. UnitedHealth, Humana, and Aetna (and others) saw lower star ratings, and UnitedHealth, Humana, and Elevance filed lawsuits against the federal agency. As a result, CMS had to pay the insurers (it ponied up $200 million to Centene in December 2024), and revisited whether the call center metric was a hill worth dying on.
