On Oct. 10, 2024, The Centers for Medicare & Medicaid Services (CMS) released the 2025 Medicare Advantage Star Ratings. CMS uses Medicare Advantage Star Ratings to measure the quality of health and prescription drug services provided by Medicare Advantage (MA) and Part D plans. The Star Ratings system helps people with Medicare compare the quality of different MA and Part D plans so they can make informed decisions about their healthcare coverage.
The Star Ratings provide information about the quality of care, along with information about benefits and costs. CMS also uses Star Ratings to incentivize MA and Part D plans to continually improve the quality of their services and strive for higher quality.
The Star Ratings also influence CMS payments to MA plans. Higher-rated plans receive larger bonus payments, which can have significant financial implications for plans.
How do Star Ratings work?
CMS reviews MA-PD (Medicare Advantage plans that combines Part A (hospital insurance), Part B (medical insurance), and Part D (prescription drug coverage) into a single plan) contracts on up to 40 quality and performance measures. Meanwhile, CMS measures MA-only contracts on up to 30 measures, and PDP (Part D prescription drug coverage only) contracts on up to 12 measures.
CMS establishes thresholds called “cut points” for each measure to determine the star rating (1-5 stars) a plan receives for that measure. Higher performance generally leads to higher star ratings. Measure star ratings are combined to calculate domain ratings (average star ratings for measures within similar service categories), summary ratings (weighted averages of measure stars for Part C and Part D separately), and an overall rating for MA-PD plans.
The calculation of summary and overall ratings uses weighted averages, giving higher importance to certain measures, such as improvement measures, patient experience, and access measures.
Star Ratings are published annually on the Medicare Plan Finder website and affect the following year’s open enrollment period. Plans with higher star ratings tend to attract more enrollees, while plans with lower ratings may struggle to maintain enrollment.
What are recent Star Rating trends?
Several trends have materialized in Medicare Advantage Star Ratings following the release of 2025 Star Ratings, including:
Declining percentage of four-star plans
The portion of MA plans achieving four stars or higher has declined for three consecutive years, indicating that it is becoming challenging for plans to achieve high ratings.
Cut point increases
Many measure-level cut points have increased, meaning plans must demonstrate higher performance to earn higher star ratings. That increase results from improved plan performance and CMS policies aimed at driving quality improvement.
Impact of Tukey outlier deletion
The implementation of Tukey outlier deletion has affected cut-point calculations and may contribute to the difficulty in achieving higher star ratings. Tukey outlier deletion aims to reduce the influence of outlier performances on results.
Industry concerns
Insurers are expressing growing concerns about the Star Ratings system, with some appealing scores and even filing lawsuits against CMS. These concerns often revolve around the complexity and perceived arbitrariness of certain aspects of the rating methodology.
What happened to Star Ratings in 2025?
In 2025, the number of Medicare Advantage plans receiving high Star Ratings continued to drop for the third consecutive year. Only seven MA plans with prescription drug coverage received five-star ratings in 2025, a decrease from 74 in 2022, and 38 in 2024. Only 40% of MA-PD plans earned four or more stars, down from 68% in 2022.
The increasing difficulty in scoring well is partly due to rising cut points, the performance thresholds plans must meet to achieve higher ratings. Wakely Consulting Group found that most cut points increased from 2024 to 2025, decreasing the average plan Star Rating from 4.07 to 3.92. In 2022, the average plan Star Rating was 4.37.
CMS acknowledges that increases in measure-level cut points make it harder for plans to receive high Star Ratings. These increases are due to improved overall performance of MA plans, pushing the bar higher, and CMS policies intended to drive continuous quality improvement.
With the decline in 4-star plans, what percent of beneficiaries will be in a 4-star Medicare Advantage plan in 2025?
Approximately 62% of enrollees in Medicare Advantage plans with prescription drug coverage (MA-PD) are projected to be in contracts with four or more stars in 2025. Approximately 90% of MA-PD enrollees enrolled in plans with four or more stars in 2022.
CMS expects changes in Star Ratings year over year as they reflect measurement period performance. Also, CMS recalculates cut points annually.
However, it is important to note that these projections are based on current enrollment figures and the 2025 Star Ratings. Actual enrollment may vary depending on plan availability, costs, and beneficiary choices during the open enrollment period, which began October 15.
Who were some of the winners and losers from the 2025 Medicare Advantage Star Ratings?
Winners include:
Insurtechs
Alignment Healthcare and Clover Health stand out as winners, with Clover Health experiencing a significant improvement. 95% of its members are in its 4-star PPO plan, up from 3.5 stars in 2024. Alignment Healthcare maintained a 4-star rating for its largest contract in California and achieved a rare 5-star rating for its HMO contract in North Carolina. Alignment is positioned favorably in California, where many large plans experienced Star Rating declines.
High-Performing Plans
Seven MA-PD contracts secured the prestigious 5-star rating in 2025, including plans from Alignment Health Plan, HealthSun Health Plans (Elevance Health), Highmark Blue Cross Blue Shield, Leon Health, MCS Advantage Classicare, Network Health Medicare Advantage Plans, and Optimum HealthCare (Elevance Health). These plans benefit from year-round marketing opportunities, unlike plans with lower ratings that can only market during the limited open enrollment period. Additionally, plans 4 stars or higher receive quality bonus payments, allowing them to offer enhanced benefits, lower costs, or provide additional services not covered by traditional Medicare.
Non-profit Plans
Non-profit organizations outperform for-profit organizations in the Star Ratings system. Approximately 50% of non-profit MA-PD contracts received four or more stars, compared to 36% of for-profit MA-PDs. This trend is consistent with PDP contracts, where 41% of non-profits achieved four or more stars compared to 17% of for-profits.
Losers include:
Traditional Giants
The 2025 Star Ratings were less favorable for established players like UnitedHealthcare and Humana. UnitedHealthcare saw its average Star Rating decrease by 0.39, while Humana experienced the largest drop at 0.74. Humana’s stock price took a significant hit due to the decline, with 70% of its members now in plans with 3 or 3.5 stars, compared to 88% of Aetna members in those rating categories. The ratings drop could impact revenue and market share, particularly if beneficiaries switch to higher-rated plans during open enrollment.
Blue Cross Blue Shield Plans
Several Blue Cross Blue Shield plans, including BCBS Florida (Guidewell) and BCBS Minnesota, also faced notable drops in Star Ratings, although BCBS Minnesota managed to stay above four stars on average. This performance could impact their competitiveness in respective markets.
Low-Performing Plans
Eight contracts received a “low-performing” icon for consistently low-quality ratings, including seven MA-PD contracts and one PDP. Notably, most of these low-performing MA-PD plans are operated by Centene Corporation, highlighting potential areas for improvement within their network. Zing Health also had one of the lowest-performing contracts, signaling concerns about their quality of care. Consistently low performance not only discourages beneficiary enrollment but can also lead to penalties from CMS.
Learn more:
Medicare Advantage star ratings 2025—Who are the winners and losers?
US health agency releases 2025 quality ratings for Medicare plans
Medicare Advantage star ratings decline: 5 things to know
2025 Medicare Advantage Star ratings: Number of 5-star plans continue to drop
A Cut Above the Rest: Summary of 2025 Star Rating Cut Point Changes
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