Stability returns to Medicare Advantage star ratings

One word defined Medicare Advantage (MA) star ratings this year: stability.

The Centers for Medicare and Medicaid Services (CMS) publicly released much-anticipated 2026 star ratings on Oct. 9. These ratings, ranked from one to five, determine the distribution of billions of dollars in quality bonus payments from CMS for plans ranking four or higher.

Over the last few years, the weighted proportion of members in plans with four or more stars has jumped around dramatically from 79.5% in 2024 to 64.1% in 2025, according to an analysis from consulting firm HealthScape Advisors. But for 2026, the proportion stayed pretty stable at 63.5% by HealthScape’s calculations.

“In some ways, stability is a good thing, especially given how volatile the Medicare market is these days. But the flip side of that is we didn’t really see meaningful improvement,” Alexis Levy, senior partner at HealthScape Advisors, told Healthcare Brew.

Rewinding. Plans have had a rough few years. Their 2024 star ratings were lower than anticipated after CMS adopted a new methodology to calculate star cutoffs, prompting insurer layoffs and lawsuits against CMS for how it calculated its scores.

CMS eventually recalculated its 2024 ratings, translating to about $1 billion more in bonus payments, according to healthcare analytics firm Cotiviti.

Plans took issue with the 2025 ratings as well, though. Humana, Centene, and UnitedHealthcare sued CMS over how it calculated its call center measure, which looks at factors like average hold times and disconnect rates. (UnitedHealthcare and Centene won; Humana lost.)

Winners and losers. Stability isn’t good news for everyone, however.

On one hand, some major payers benefited. UnitedHealthcare Group, Elevance, and Centene saw their estimated members in plans with four or more stars increase for 2026, with Centene seeing the largest jump from 1% of its members in plans that met that threshold to 19.8%, according to healthcare consultancy Wakely’s October report, based on September 2025 enrollment.

The Kaiser Foundation Health Plan maintained nearly 100% of its members in four-star or higher-ranking plans.

But Humana, the second largest MA insurer with 5.8 million members, isn’t doing so great.

Humana’s star ratings saw the largest drop of the top 15 insurers in 2025, according to a 2024 HealthScape analysis. According to an October 2024 8-K filing, enrollment in plans of four or more stars fell from 94% for 2024 to 25% for 2025.

For 2026, the proportion of members in plans four stars and above went down even further, to 20%.

Humana said in an Oct. 2 form 8-K filing it’s “not satisfied” with its 2026 ratings but has already made changes that should allow it to get back on top for 2027.

The payer will not be “actively selling” most plans in its largest MA contract—which currently has 3.5 stars—and will instead steer new customers toward four- and 4.5-star plans while also focusing on improving other measures that determine star ratings, like member engagement and the call center experience, Humana CEO and President Jim Rechtin said in an update posted Oct. 2.

Looking forward. Based on these ratings, Wakely’s analysis predicts “approximately the same” quality bonus payments in 2027 as in 2026.

In 2025, CMS will dole out $12.7+ billion, according to an estimate from KFF. These payments are meant to be reinvested to benefit plan members, though some researchers say there’s not enough evidence this happens.

Levy thinks this year could lend itself to less legal drama, at least.

“There weren’t as many huge programmatic changes to the measure calculations that a lot of the plans were suing over in the previous years,” Levy said.