How Plans Can Win As Medicare Advantage Star Ratings Change
There are a lot of stories inside the Medicare Advantage Stars data for 2026. Most noticeable is the fact that insurer ratings remained relatively flat from 2025 and earning four-plus stars — along with the coveted bonus payment — remains elusive. Digging deeper though, we see trends that continue to reshape the Medicare Advantage market, including the improved performance of provider-sponsored plans and limited options for beneficiaries in rural communities.
As insurers continue to exit markets and reduce plan offerings, Star ratings take on heightened importance for seniors on their shopping journey. There was a modest increase in ratings for Stars Year (SY) 2026 compared to SY 2025. We identified three broad trends in the SY2026 data:
- The share of four-plus Star contracts stayed flat at 40% of all contracts in SY2026. This is the lowest number of in-bonus contracts over the last five-plus years
- The share of five Star contracts increased to 3% of all contracts in SY2026, compared to only 1% in SY2025
- The percentage of Medicare Advantage members in bonus earning contracts, based on September 2025 enrollment, increased slightly to 64% SY2026, but is still well below the more than 70% rates seen in SY2021-2024
Struggles for national insurers continue
In recent years, largest national plans including Aetna, Elevance, Humana, and UnitedHealthcare have steadily lost ground in Stars performance compared to regional and provider-owned plans. Blue Cross and Blue Shield plans lead the way for SY2026 with 64% of their membership enrolled in four-plus Star plans, slightly ahead of large national plans at 62%.
Notably, several major players such as Centene, Elevance, and UnitedHealthcare filed lawsuits against the Centers for Medicare and Medicaid Services this year after receiving sub-four-star ratings, underscoring the pivotal importance of the Stars program for their financial and reputational standing.
Meanwhile, provider-sponsored plans continue their impressive trajectory, boasting 86% of members in contracts rated four-plus Stars. This strong performance likely reflects providers’ greater capability to directly influence and monitor clinical quality measures.
Location matters for Star ratings
Our previous article on the Medicare Advantage open enrollment period highlighted the trend of plans exiting rural markets due to ongoing financial sustainability challenges. Our analysis of Stars scores by geography reveals a parallel challenge — plans serving predominantly rural areas struggle to achieve four-plus Star ratings.
While plans with the majority of membership in large and medium metropolitan areas report that over 70% of members enrolled in four-plus Star contracts, those with a significant rural membership have fewer than 41% of members in such high-performing plans.
Since the Stars quality bonus can be pivotal for plan profitability, carriers must develop targeted strategies to improve Stars performance in these geographically dispersed rural markets, addressing unique local challenges to remain competitive and financially viable.
Factors driving changes in Star ratings
Several changes for calendar year 2026 will have a material impact on measure weighting and, consequently, plan strategies. Chief among those is the reduction in the weighting of CAHPS/complaints and text-to-voice teletypewriter (TTY) measures, going from a four-times and five-times weighting respectively in SY2025 to a two-times weighting for SY2026. This adjustment reduces their overall contribution from approximately 55% of the total Stars score in SY2025 to 37% in SY2026.
As a result of this shift, clinical HEDIS and Part D measures have gained greater relative importance, especially those that remain triple-weighted, including transitions of care and Part D medication adherence measures.
The program’s historic emphasis on CAHPS surveys drove many plans to focus heavily on member experience. Now, plans must realign their quality improvement priorities by intensifying efforts on clinical outcomes and medication adherence to sustain or enhance their Stars ratings.
How insurers can future-proof their strategies
Plans are already managing their SY2027 performance while simultaneously preparing for the 2026 measurement year, which will directly influence the SY2028 Star Ratings. The most pivotal change affecting 2027 and beyond is the introduction of the Excellent Health Outcomes for All index (EHO4all), formerly known as the Health Equity Index (HEI), which replaces the previous reward factor.
The EHO4all marks a major evolution in the Medicare Advantage Stars program. Starting with data collected in 2024 and impacting ratings from SY2027 onward, it incentivizes plans that enroll a substantial proportion of members facing social risk factors, including those in Medicaid, the Medicare Savings Program, or receiving the low-income subsidy, and demonstrate strong performance for these vulnerable populations.
Ongoing success for Medicare Advantage plans will hinge on three critical factors:
- Elevating clinical quality measures
- Integrating comprehensive health equity strategies
- Leveraging advanced technology to engage and support socially at-risk populations effectively
With the bar constantly rising, plans that innovate and adapt will be best positioned to deliver superior care and secure the financial incentives tied to strong Star Ratings.