The Centers for Medicare & Medicaid Services (CMS) quietly released the 2026 Medicare Advantage Star Ratings in early October. The ratings are the federal government’s primary tool for measuring the quality and performance of private MA and Prescription Drug Plans (PDPs). Ranging from 1 to 5 stars, these ratings are designed to help beneficiaries choose their plans during the annual fall open enrollment. They are equally important for insurers, as a 4-star or higher rating unlocks Quality Bonus Payments (QBP).
Here’s a look at the 2026 MA Star Ratings:
What are MA Star Ratings?
The Star Ratings program is a system developed by CMS to provide quality and performance information to Medicare beneficiaries. The program helps enrollees choose their health and drug services during the annual fall open enrollment period.
The ratings are calculated at the contract/sponsor level. They range from 1 to 5 stars, with 5 stars being the highest possible score. The methodology for calculating Star Ratings involves a hierarchical framework encompassing four levels: Measures, Domains, Summary Ratings, and the Overall Rating.
The 2026 Star Ratings include a maximum of 45 measures grouped into nine domains. The scores for these measures are derived from four categories of data sources:
- Surveys of Enrollees
- Health and Drug Plans
- Data Collected by CMS Contractors
- CMS Administrative Data
Each measure receives a numeric score. That score is then converted into a Star Rating ranging from 1 to 5 stars.
What trends emerged in the 2026 Medicare Advantage Star Ratings?
Several notable trends emerged in the 2026 MA Star Ratings, reflecting a period of stabilization after prior declines, but also demonstrating shifts in performance and enrollment among major carriers.
Overall Market Stabilization and Enrollment in Highly Rated Plans
After years of consistent declines, Star Ratings have stabilized for the 2026 period. When looking at the top 15 plans by enrollment, the average Star rating increased nominally to 3.99, up slightly from 3.93 in the prior year. An estimate from investment bank TD Cowen showed weighted average stars for all plans rising slightly from 3.96 to 3.98.
The percentage of Medicare Advantage enrollees in plans with four or more stars is roughly on par with last year’s performance. Approximately 64% of MA enrollees are in 4+ star plans, and more specifically, 63.5% of membership is attributed to a 4+ Star plan, a slight decrease from 64.1% the prior year. Enrollment in 5-Star plans remains negligible but increased marginally to 2.3% of members, up from 2.0% in 2025. This is still down from its peak of 27% in 2022. Enrollment in plans with less than 3 Stars remained steady at approximately 1%.
Major Carrier Performance Shifts
While the industry average was stable, individual major carriers experienced different results in the percentage of their members enrolled in high-performing plans (4 stars or above). This shift in membership tiers will have an economic impact due to changes in Quality Bonus Payments (QBP). See below for some of the winners and losers.
Changes in CMS Methodology and Market Reaction
The general stabilization of ratings occurred despite regulators making the highest ratings more difficult to achieve, including upping standards after the coronavirus pandemic and eliminating outliers from calculations.
The CMS changes implemented for the 2026 ratings, noted in the technical documentation, included:
- Weight Reduction: The weight of patient experience, complaints, and access measures was decreased from 4 to 2.
- New Measures: Several re-specified or new measures were included. Those include Improving or Maintaining Physical Health (C04), Improving or Maintaining Mental Health (C05), and Kidney Health Evaluation for Patients with Diabetes (C13), initially weighted at 1.
- Strategic Responses: In response to margin pressures, large payers like UnitedHealthcare, Humana, and Aetna reduced the number of states and counties they serve for 2026. Humana also stated it intends to pursue “contract diversification,” shifting members into more highly rated contracts, for 2027 to mitigate revenue losses.
- Impact on Margins: Plans that saw their ratings decline will face lower revenue due to the loss of the QBP, potentially leading them to cut supplemental benefits or increase premiums for 2027
Who were some of the winners and losers in the 2026 Medicare Advantage Star Ratings?
Winners
The biggest winners generally showed significant improvement in their average rating or successfully moved a large portion of their membership into the lucrative 4-star and 4.5-star tiers.
| Carrier | Improvement Metric | Key Data Points |
|---|---|---|
| UnitedHealth Group (UHG) | Increased High-Star Enrollment | UHG, the largest MA insurer, increased its members in plans rated 4 stars or higher to 78%, up from 75%. UHG’s average Star rating increased by 0.25 and is now above 4 Stars. It saw a net positive shift of +7.1 percentage points in membership to plans above 4 Stars. |
| Centene | Dramatic Improvement | Centene posted an in the percentage of its MA members in plans with four or more stars, jumping from 1% last year to 20% this year (or greater than 18% next year). Centene saw a notable net positive shift of +19.5 percentage points in membership to plans above 4 Stars. Its average rating improved from 3.14 Stars (2025) to 3.39 Stars (2026). |
| Elevance Health (Anthem) | Significant Jump in High-Star Enrollment | The percentage of its 2.2 million MA members in plans with at least 4 stars increased by 14 percentage points year-over-year, reaching 53%. This improvement was primarily attributed to one large contract moving from 3.5 to 4 stars. |
| GuideWell (Florida Blue) | Major Enrollment Shift | GuideWell Health saw a highly favorable shift, moving nearly 24% of its membership from 3-Star plans to 4-Star plans. Its average rating increased by 0.30 Stars and is now above 4 Stars. |
| Kaiser Permanente | High Stability at Top Tier | Kaiser, the fifth-largest MA insurer, maintains a high level of quality, with virtually all members remaining in plans with at least 4 stars. Several Kaiser contracts are listed with an Overall Rating of 4.5 stars. |
| Alignment Healthcare | Consistent Top Performance | Alignment Healthcare once again achieved 100% of its members in 4-plus star plans. |
Losers
The major losers are those carriers that saw a substantial decline in the percentage of members in the 4-star or higher tiers, which directly impacts their revenue and ability to offer competitive benefits.
| Carrier | Decline Metric | Key Data Points |
|---|---|---|
| Clover Health | Catastrophic Drop | Clover Health was identified as perhaps the biggest loser. Its largest contract, covering almost all (97%) of its MA members, dropped below 4 stars. Analysts estimated this slip could cost the insurer tens of millions of dollars in earnings. |
| Humana | Significant Enrollment Decline | Humana saw its enrollment in highly rated plans drop. It expects only 20% of its members to be enrolled in plans with at least four stars, a decrease from 25% in the 2025 plan year. Its average star rating for 2026 is 3.61. Furthermore, Humana’s largest contract (H5216) remains below 4 Stars. |
| Aetna (CVS-owned) | Enrollment Decline from Peak | Aetna’s overall star ratings performance declined. While still leading peers, the percentage of members in plans with four or more stars dropped to more than 81%, down from 88% (or 89%) in 2025. This drop translates to lower Quality Bonus Payments (QBP) for a substantial portion of its membership. |
| Lifetime Healthcare (Excellus) | Major Tier Shift | Lifetime Healthcare (Excellus) saw nearly 35% of its enrollment shift from the 4-Star tier into the 3-Star tier. |
| Health Care Service Corporation (HCSC) | Significant Decline in Average Rating | HCSC experienced an average decline of 0.30 Stars, and its average rating remains below 4 Stars. It also saw a significant negative shift of -13.2% in membership out of the 4 and 5 Star tiers. |
| SCAN | Declined Average Rating | SCAN saw an average decline of 0.47 Stars, though its average rating remains above 4 Stars. |
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