The Medicare Advantage Star Ratings decline has left many people confused while comparing plans for 2026. If you’ve noticed fewer 4- and 5-star plans or saw your plan’s rating drop, you’re not alone. Medicare Advantage (MA) plans are graded annually on a 1–5 Star Ratings scale, measuring clinical care, member satisfaction, preventive services, complaints, and overall performance.
Although averages show slight stabilization, ratings remain below pre-pandemic highs. Even small rating shifts can affect benefits, premiums, and plan availability making it critical to understand what’s happening before you enroll or switch coverage.
Star Ratings Overview
Here’s the big picture:
- The weighted average rating increased slightly from 3.96 to 3.98 (nearly flat year over year).
- About 64% of Medicare Advantage members are enrolled in plans rated 4 stars or higher.
- Fewer contracts achieved 4.5 or 5 stars compared to peak years.
- Ratings remain below pre-pandemic performance levels.
While averages stabilized, this follows several years of downward pressure caused by stricter scoring rules and higher performance thresholds.
Which Insurers Improved and Which Fell Behind?
Among the largest Medicare Advantage carriers:
Improved or Stable Performance
- UnitedHealthcare: Approximately 77–78% of members remain in 4+ star plans.
- Elevance Health: Significant improvement, with 53% of members in 4+ star plans (up from ~40%).
- Centene Corporation: Jumped from about 1% to nearly 18–20% of members in 4+ star plans.
Declines in Highly Rated Enrollment
- Humana: Dropped from 25% to roughly 20% in 4+ star plans.
- Aetna (owned by CVS Health): Declined from around 88–89% to approximately 81%.
- Clover Health: Fell below the 4-star benchmark on its largest contract.
These shifts may significantly affect bonus payments and long-term profitability.
Why Star Ratings Are Under Pressure
Several structural changes explain the Medicare Advantage Star Ratings decline:
Stricter CMS Methodology
Pandemic-era flexibilities were removed, and performance cut-points were recalculated — making 4- and 5-star ratings harder to achieve.
Higher Performance Benchmarks
Low-performing outliers are excluded in certain calculations, which raises scoring thresholds.
Increased Healthcare Utilization
Older adults are using more healthcare services post-pandemic, increasing costs and complicating performance management.
Risk Adjustment Updates
Changes to reimbursement formulas have tightened margins and increased operational pressure for insurers.
Financial Impact on Plans
Star Ratings directly influence:
- 5% quality bonus payments for plans rated 4+ stars
- Larger rebates for competitive bids
- Marketing advantages during enrollment
Plans that fall below 4 stars lose access to critical bonus revenue. As a result, some insurers are:
- Reducing service areas
- Narrowing provider networks
- Adjusting supplemental benefits
- Increasing premiums or cost-sharing
Several national carriers have reduced the number of counties or states they serve in 2026.
What This Means for Medicare Members
For Medicare Advantage members, the ratings decline could result in:
- Fewer 4+ star options in certain counties
- Adjustments to extra benefits like dental, vision, or OTC allowances
- Network changes
- Higher out-of-pocket costs
However, 5-star and 4.5-star plans still exist, and some regional or nonprofit carriers continue to outperform larger national brands.
Key Quality Trends in 2026
Notable patterns include:
- Slight increase in 5-star plans compared to 2025 (still below historical highs)
- Growth in 3–3.5 star contracts
- Provider-sponsored health plans experiencing volatility
- Continued expansion of Chronic Condition MA plans
Performance varies significantly by contract not just by brand name.
FAQs
Did ratings decline in 2026?
Overall averages remained nearly flat compared to 2025 but remain below pre-pandemic levels. Some major insurers improved, while others saw declines in highly rated enrollment.
Why do Star Ratings matter?
Plans rated 4 stars or higher receive quality bonus payments, which help fund supplemental benefits and competitive premiums.
Are fewer people enrolled in high-rated plans?
About 64% of Medicare Advantage members are in 4+ star plans slightly below peak years.
Will benefits change?
Plans that lose bonus payments may adjust benefits, provider networks, or cost-sharing in future years.
Final Takeaway
The Medicare Supplement Insurance reflects a broader recalibration in the MA market. While average ratings stabilized in 2026, competition has intensified under stricter regulatory standards and rising healthcare costs.
For Medicare members, this is a strong reminder to compare plans carefully each year looking beyond premiums to Star Ratings, provider networks, supplemental benefits, and overall long-term value.
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