To encourage insurers to perform well and help people choose a Medicare Advantage plan, The Centers for Medicare and Medicaid Services (CMS), which administers Medicare, rates the performance of insurers offering Medicare Advantage plans through a five-star rating system. Based on this year’s star-ratings, Medicare Advantage plan performance is worsening. Susan Morse reports for HealthCare Finance that CMS gave five star ratings for just seven insurer Medicare Advantage contracts (1.79 percent of contracts), down from 38 in 2024.
The government’s star-rating system should help people appreciate the quality of different MA plans but it is largely a farce because it misleads people into believing that they can choose a high-quality plan. In truth, CMS does not have the data to distinguish among MA plans effectively. Its ratings are based on insufficient data that lumps together lots of different MA plans offered by an insurer under one government contract, even though the MA plans can have different networks and different rules and processes for covering care.
As it is, MA plans with five stars can have high rates of inappropriate delays and denials of care, particularly for people needing hospital, skilled nursing and rehab services, inadequate networks, and high mortality rates. The star-rating system won’t help people pick plans that meet their current and future needs.
CMS is working to improve its star-rating system. But, it doesn’t yet have enough complete, accurate and timely date from the Medicare Advantage insurers to deliver effective ratings. The insurers offering the plans don’t release the data that CMS would need or don’t release reliable data. As a result, at best, the star-rating system tells people which plans to avoid. Don’t consider enrolling in a plan that has three or fewer stars.
Here are the MA plans that got five stars: Alignment Health Plan; HealthSun Health Plans by Elevance Health; Highmark Blue Cross Blue Shield; Leon Health; MCS Advantage Classicare; Network Health Medicare Advantage Plans; and Optimum HealthCare by Elevance.
UnitedHealthcare, which covers the largest number of Medicare Advantage enrollees, lost its five star ratings this year and has sued the government. So has Humana, which in 2025 only has 25 percent of its enrollees in four or five-star plans, down from 94 percent in 2024.
CMS gave the Medicare Part D prescription drug plans even lower ratings, with only 40 percent of them receiving four or five stars. People should know that Part D insurers often charge higher copays for drugs on their formularies than the full cost of the drug through Costco or Mark Cuban, and they often don’t cover the drugs that your doctor prescribes.
Here’s more from Just Care:
- Don’t assume a five-star Medicare Advantage plan will provide the care you need
- Medicare hospital star-ratings are a farce
- Medicare Part D drug costs: What to expect in 2025
- Insurers incentivize Medicare Advantage brokers to steer you away from Traditional Medicare
- 2024: What to know this Medicare Open Enrollment Period
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