Humana is suing CMS over star ratings—again

Humana is giving us whiplash.

On July 17, a US District Court for the Northern District of Texas judge dismissed the company’s lawsuit against the Centers for Medicare and Medicaid Services (CMS) and Department of Health and Human Services over its 2025 star ratings.

Then, not even a week later on July 22, Humana filed a new suit against CMS, once again contesting its 2025 star ratings, a Medicare Advantage (MA) plan quality metric tied to bonus payments.

In an 8-K filed Oct. 2, 2024, Humana said it was left with only 25%—or 1.6 million of its members—in plans with ratings above 4 stars in 2025. In 2024, for comparison, 94% were in 4+ star plans.

A fact sheet from CMS contends star ratings are based on many performance and customer satisfaction measures and variations in star ratings from year to year are normal because each plan’s performance varies.

The nitty gritty. Humana’s lawsuit was thrown out because, the judge asserted, the payer “did not exhaust the administrative appeals process” before suing CMS in October over its low star ratings—i.e., Humana went running to court before it got an answer on an internal appeal to CMS.

Humana got a final decision on its internal appeal to CMS in April (CMS said no), but what matters is the payer hadn’t received that decision when it first filed the suit.

New suit, who dis? The new filing alleges CMS didn’t properly test the company, dinging Humana’s star ratings “on the basis of just three phone calls that were handled by CMS in a manner inconsistent with the agency’s own regulations.”

Humana is one of many insurers that has sued the US government over star ratings, though it saw the largest rating drop of any major insurer, according to consulting firm Healthscape.

While Humana’s suit has dragged on, payers like Centene, UnitedHealth, and Alignment Healthcare have won their star ratings court battles and gotten some of their plans’ ratings recalculated. BCBC Minnesota, Florida Blue, and BCBS Louisiana have either dropped or lost their suits.

The new suit requested a rating change before the annual open enrollment period, which starts Oct. 15.“Plaintiff Humana is already suffering reputational harms from the inaccurate 2025 star ratings, harms that will grow substantially once the annual enrollment period begins,” the suit reads.