Medicare Advantage Star Ratings Plummet: How Plans Are Fighting Back
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The once-coveted five-star rating in Medicare Advantage is becoming increasingly elusive, forcing health plans to rethink their strategies for success.
Maintaining a high Star Rating in the Medicare Advantage (MA) landscape is more challenging than ever. Evolving regulations from the Centers for medicare & Medicaid Services (CMS), shifting quality measures, and rising performance thresholds are creating significant pressure on MA plans to adapt or risk falling behind. The stakes are exceptionally high, wiht a dramatic decline in top-rated plans signaling a new reality for the industry.
In 2022, 74 Medicare Advantage contracts achieved a five-star rating. Though, by 2025, that number had plummeted to just seven. This sharp decline underscores a harsh truth: achieving and sustaining high performance is now the exception, not the norm. The 2026 CMS Final Rule and Rate Proclamation further emphasize the need for adaptability, with the agency signaling a shift toward faster rulemaking processes with limited public input.
One regional MA plan experienced this shift firsthand. After years of hovering around a three-star rating, the plan’s performance dropped to 2.5 stars following the release of the 2023 Star Ratings in Fall 2022. rather than accepting this as certain, the institution embarked on a complete overhaul of its Star Ratings strategy.
A Wake-Up Call for a dual-Eligible Plan
Serving nearly 300,000 members, including approximately 14,000 Medicare beneficiaries – 85% of whom are enrolled in a Dual Eligible Special Needs Plan (D-SNP) – the plan had previously aimed for a rating between 3.5 and 4 stars. However,performance had been inconsistent. the 2.5-star rating in 2023 proved to be a turning point, revealing that the plan’s existing strategy lacked the data-driven precision required to navigate the increasingly complex CMS habitat.
building a Multi-Year Roadmap to Betterment
Rather of pursuing a quick fix, the plan adopted a purposeful, multi-year strategy:
- Year 1: Move from 2.5 to 3 stars
- Year 2: Reach 3.5 stars
- Year 3: Achieve 4 stars
This phased approach allowed the quality team to focus on incremental gains, improving key performance measures and aligning internal stakeholders without overwhelming resources or setting unrealistic expectations. The plan also implemented a flexible goal-setting framework, adjusting targets based on its D-SNP population and eligibility for CMS’
“If I had to call out one best practice that’s really driven our success-it’s the discipline of consistent performance evaluation,” noted the Director of Quality Data Insights and Performance.”It creates space for data-driven decisions, early course correction, and shared accountability across teams.”
An Action Plan for Star Ratings Success
here’s a specific action plan for MA plans aiming to replicate this success:
Next Week: Prioritize high-weighted measures, set realistic and attainable goals, and evaluate all stakeholders and tools.
Next 90 Days: Develop multi-year Star workplans, assess reporting needs and add support/tools, and work collaboratively with stakeholders across the plan and with vendor partners.
Next 365 Days: Schedule quarterly strategic meetings, continue to look at Stars across multiple years, and publicize goals and celebrate wins.
Ready to transform your Star Ratings strategy? Cotiviti’s Star Intelligence platform empowers health plans to forecast performance using predictive analytics, set and adjust data-driven goals, align stakeholders with actionable insights, and adapt quickly to regulatory changes.
If your health plan is facing declining ratings, challenges adapting to CMS requirements, or stagnant strategies, now is the time to act. Read our fact sheet and learn how Star Intelligence can power your next leap forward.
Interested in a personalized demo? Connect with our team and we’ll be in touch quickly to set one up.
