Medicare Advantage star ratings: changes, and what’s in it for you!
In a November 26, 2025 AXIOS article by Maya Goldman, she stated:
The Trump administration is proposing to scrap a dozen quality measures for Medicare Advantage plans and not move forward with a Biden administration plan to reward insurers that improve the health of low-income and disabled enrollees.
Why it matters: A proposal issued on Tuesday marked the Trump administration's first shot at putting its mark on the privatized Medicare program and delivered a mixed bag for top plans like UnitedHealth Group and CVS Health's Aetna.
Driving the news: The administration is taking aim at the star ratings that plans get based on performance metrics and determine whether they get bonus payments.
Medicare is proposing to not implement a Biden-era change that was due to take effect in 2027 and would give plans extra incentives for improving health outcomes for low-income and disabled seniors. The administration would instead continue the current system, which rewards plans that achieve high and stable performance across measures.
"This shift is part of a broader effort to refocus the Star Ratings on clinical care, outcomes, and patient experience," the Centers for Medicare and Medicaid Services wrote in the proposal.
Medicare administrators estimate the star ratings changes would cost taxpayers about $13 billion between over a decade, or 0.15% of Medicare payments to private health plans during the time period.
CMS also is seeking feedback on future changes to the Medicare Advantage risk adjustment, which allows plans to get paid more for having sicker enrollees. Some insurers have been accused of "upcoding" — a practice of classifying patients as sicker in order to receive higher payments.
Between the lines: CMS is proposing to remove 12 quality measures, including two measures of how plans respond to appeals of claim denials.
✍️ Jon’s Take
If you’re like me, you probably read headlines about Medicare policy changes and think,
“Why should I care?”
That’s exactly why I wanted to break this down.
Star ratings may sound like an inside-baseball issue for insurance companies, but they have real consequences for everyday Medicare members. They influence how much money plans receive and, ultimately, what benefits and costs you experience.
Here’s the plain-English version of why they matter.
✨ Why Proposed Star Rating Changes Matter to You
Medicare Advantage star ratings aren’t just report cards. They directly affect how plans are funded.
Plans that earn 4 stars or higher qualify for Quality Bonus Payments from Medicare. Those extra dollars are often used to:
• Lower premiums
• Reduce copays
• Add dental, vision, or hearing benefits
• Expand care management and customer support
When ratings change, funding changes. And when funding changes, so can your benefits.
🚩 A Note on Low-Rated Plans
Plans that consistently score below 3 stars face serious consequences, including the possibility of losing their Medicare contract altogether. Even before that happens, low ratings can limit a plan’s ability to compete, attract providers, and invest in member services.
In short, ratings don’t just reflect quality. They influence it.
🧠 What This Means When You’re Choosing a Plan
When you’re comparing Medicare Advantage plans, star ratings help answer important questions:
✔ Is this plan consistent year over year?
✔ Do members generally report good experiences?
✔ Does the plan invest in preventive care and chronic condition management?
They’re not perfect, but they’re one of the clearest tools Medicare provides to help consumers compare plans.
✨ Bottom Line
Medicare Advantage star ratings shape how plans are paid, how benefits are built, and how competitive a plan can be.
They don’t tell the whole story, but they tell an important one.
When reviewing coverage options, don’t skip past the stars.
They’re there for a reason.
💭 Jon’s Closing Thought
Personally, I’d love to see ratings place even more emphasis on how easy it is to access care and how affordable that care truly is for members. Those factors matter deeply in everyday life, and they’re often what people feel most when something isn’t working.
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Higher-rated Medicare Advantage plans receive bonus funding from Medicare. Many plans use that extra funding to reduce premiums, lower copays, or add extra benefits. However, costs can still vary based on provider networks, prescriptions, and how often you use care.
Star ratings are a helpful signal, but they should never be the only factor you consider.
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Yes. Star ratings are updated annually based on a plan’s recent performance.
A plan that was highly rated last year may receive a different rating this year depending on quality scores, member experience, and compliance measures. That’s why it’s important to review your plan every year, even if nothing seems wrong.
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A 5-star rating can be a strong indicator of quality, but it doesn’t automatically mean the plan is the best fit for you.
Some 4-star plans may:
• Have a stronger local provider network
• Cover your medications better
• Offer lower out-of-pocket costs for your specific needsThe right plan balances quality, access, and affordability.
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If your plan’s rating drops, it doesn’t mean your coverage disappears. But over time, lower ratings can affect:
• Future benefits
• Premium stability
• Extra perks
• Plan availabilityIt’s a good idea to review your options if your plan experiences a significant rating change.
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No. Star ratings apply to Medicare Advantage and Part D prescription drug plans only.
Original Medicare (Parts A and B) does not receive star ratings because it is administered directly by the federal government rather than private insurers.
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Star ratings are issued at the plan contract level, not by individual doctor or hospital.
That means a plan may have a strong overall rating but still vary in network strength or service quality depending on location. Local access still matters.
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Star ratings are displayed on:
• Medicare.gov
• Medicare Plan Finder
• Plan marketing materials
• Annual enrollment noticesThey are updated once per year, typically in the fall.
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Star ratings are one of the best comparison tools Medicare provides, but they work best when paired with a personal review of doctors, medications, and costs.
If you’re unsure how to weigh star ratings when choosing a plan, getting help can prevent costly mistakes.
