The number of Medicare Advantage plans that achieved a 5-star rating in 2025 continued to drop. Star ratings have dropped consistently over the last three years. In 2022, 74 of MAPDP plans earned a 5-star rating. In 2025 only seven plans received this rating. Here’s what you need to know about Medicare star ratings in 2025.
How the Star Ratings are Determined
CMS uses up to 40 different quality and performance measures to determine a plan’s star rating. These include:
- Access to checkups, screenings, tests, and vaccines.
- How easy it is for members to get appointments and care quickly.
- How well the plan helps members manage chronic health conditions.
- The plan’s responsiveness and care based on member satisfaction surveys.
- Quality of telephonic customer service.
- How often members filed complaints and appeals.
- The number of members who choose to leave the plan that year.
- Accuracy of drug pricing and safety (whether members with certain medical conditions get prescription drugs that are considered clinically appropriate for their condition).
These factors are calculated annually and released every fall before AEP to make it easier for Medicare beneficiaries to compare and evaluate plans based on how well they performed.
What Has Changed to Impact the Ratings?
CMS scoring methodologies are complex. Thresholds, known as cut points, are set for each of the quality measures. These cut points determine a plan’s performance and ultimately their star rating. In 2024, CMS introduced a new methodology for calculating cut points, which removed extreme outliers from the data, meaning any extremely high or low scores were removed from the calculations. CMS believed this would allow for more predictable star ratings from year to year. Some insurers, however, believe that removing the outliers makes it more difficult to earn and maintain 4- or 5-star ratings. Several plans that saw a drop in their star ratings for 2025 are pursuing legal action against CMS to address this issue. It is anticipated that star ratings will continue to decrease until plans make adjustments that align with the scoring methodology changes.
How Star Ratings Impact Plans
Star ratings are intended to incentivize plans to improve their performance, and CMS rewards high performing plans with bonus payments. Star ratings not only impact a plan’s reputation in the marketplace, but they also have significant financial repercussions. 2025 star ratings will impact the 2026 quality bonus payments that plans receive from CMS. Plans with 3.5 stars or higher are eligible for bonuses, with 4.5- and 5-star plans receiving the highest level of bonus payments. The difference between three and four stars can mean millions of dollars. These dollars directly translate to what type of enhancements and supplemental benefits a plan can afford to offer.
Plans with a 5-star rating also have a marketing advantage. They can promote enrollment in their plan all year long because they have a 5-star special enrollment period, which allows Medicare Advantage enrollees to switch to a 5-star plan anytime between December 8 and November 30 of the following year. This helps them to increase enrollment and maintain an advantage over their competitors.
How Star Ratings Impact Your Clients
A 5-star rating indicates a plan that performs well and is financially stable. These plans may offer more supplemental benefits that appeal to your clients such as vision, dental, hearing, and health and wellness programs. But these are not the only factors that should be considered when choosing a plan. They should also carefully consider:
- Provider Network: Are their preferred doctors and hospitals in the plan’s network? Do they need or want out of network benefits?
- Drug Formulary: Are their prescription medications covered? Are there any special requirements that could be of concern such as quantity limits, step edits, prior authorizations, and mail order? Is their preferred pharmacy in network?
- Cost: Can they afford the out-of-pocket costs associated with the plan?
Your clients rely on you to help them find the coverage that best fits their financial and healthcare needs. You can help them understand star ratings and weigh their importance when choosing a plan.
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