Just 40% of Medicare Advantage (MA) prescription drug plans offered in 2025 achieved a score of four stars or higher, the Centers for Medicare & Medicaid Services (CMS) revealed Oct. 10.
It is the third consecutive year the portion of MA plans offering four-star plans or greater decreased, with 68% of plans meeting the threshold in 2022. Last year, 42% of plans achieved at least a four-star rating.
Weighted by enrollment, 62% of enrollees are currently in contracts with a four-star rating or better. In 2022, 90% of enrollees were in at least a four-star plan.
These star ratings impact the 2026 year quality bonus payments, which has significant financial repercussions to MA plans. They are rated on 40 measures in Medicare Advantage Prescription Drug (MA-PD) plans, 30 measures for MA plans and only 12 measures in solely prescription drug plans.
CMS noted there were no major changes to this year’s star ratings methodology but that there were small changes to calculations. They include increasing the weight for the Part C all-cause readmission measure.
Tukey outlier deletion was also added to non-CAHPS measures, leading to results less influenced by outlier performances, the agency explained. Implementing Tukey could save CMS up to $1.5 billion (PDF) by 2030, actuaries at Milliman projected.
Star ratings are designed in a way that is increasingly hard to score well. This is accomplished through cut points, otherwise thought of as the bar a plan must surpass to score in a desired range.
Most cut points have increased from 2024 to 2025, an analysis (PDF) from Wakely Consulting Group found. Therefore, the average plan star rating from 4.07 to 3.92 in 2025. Plans scored a 4.37 on average in 2022. More than one-third of plans rated in 2024 and 2025 decreased at least half a star, said Nick DiMauro, chief revenue officer for United Medco, in a LinkedIn post.
“Increases in measure-level cut points result both from contracts’ performance and from CMS policies that continue to drive quality improvement for the program,” CMS said.
The feds said cut points also increased because healthcare is returning to pre-pandemic normalcy and because scores were overall more compressed.
A growing number of plans scored highly on some measures like breast cancer screenings, while more plans scored lower on other measures like colorectal cancer screenings.
The average star ratings for breast cancer and colorectal cancer screenings were their lowest in four years.
Just seven MA-PD contracts, or 1.79%, earned a five-star rating, down from 74 contracts in 2022. At the other end of the spectrum, just 24 contracts scored 2.5 stars or worse.
More than 92% of members were in a 3.5-star MA-PD plan or better in 2024. That figure decreased slightly for 2025 to 89.84%.
“Generally, higher overall star ratings are associated with contracts that have more experience in the MA program,” a CMS fact sheet explained.
Insurers are growing increasingly agitated with CMS over star ratings scores, with Humana appealing its scores and UnitedHealth the latest to sue the agency over its results.
Open enrollment begins Oct. 15.
https://www.fiercehealthcare.com/payers/medicare-advantage-star-ratings-dip-slightly-once-again-2025
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