Star ratings, which measure quality, customer service, and the member experience, are critical to determine a health plan’s performance, bonus payments and rebates, and are key to enrollment and retention. CMS recently published its 2025 Medicare Advantage and Part D Star Ratings fact sheet. Here, we explore some of our key takeaways, how they will impact your plan, plus, how you can boost your Star ratings in 2026. Medicare Advantage Plans Are Under-Performing CMS’ most recent findings echo trends we’ve seen for quite some time. Approximately 40% of plans that will be offered in 2025 earned 4 or more stars for their 2025 overall rating—down approximately 10% from 2024. Weighted by enrollment, 62% beneficiaries are currently in contracts that will have 4 or more stars in 2025 compared with about 74% last year. CMS found that overall Star ratings have dropped significantly over the past 3 years. In 2022: 152 plans achieved 4 stars or higher, while just 116 plans could say the same for 2025. 74 plans received 5 stars, which dropped to just 7 in 2025. CMS also identified 8 contracts that are consistently low-performing plans—up from 6 contracts last year. Plans that achieve 4 stars or higher are awarded a 5% quality bonus payment. Plans can use the additional payments to cover the cost of supplement benefits, including reduced cost sharing, extra benefits not covered by traditional Medicare, and lowering Part B and/or Part D premiums. CMS noted that changes in Star Ratings year-over-year are normal, expected, and vary by measure. They also stated that cut points are recalculated each year based on performance during the measurement period, and many cut points increased from 2024, meaning that plans had to achieve higher performance on the measures to receive a high Star Rating.

With increased regulatory pressures, changing payment models, and growing complexity, payers are looking to digital health solutions to improve quality and outcomes, boost their performance, and stay profitable. In fact, 62% of health plan leaders say that investing in modern technology for digital transformation is the top way to achieve their organizational goals in the new year.

Innovation and Impact – The True Promise of Analytics It’s been an exceptionally busy quarter for the AMC Health analytics team. From groundbreaking dashboards to pioneering machine learning models, the team is resetting expectations – both internally and externally – on the value that robust data and analytics bring to patient health.

Virtual care solutions can solve some challenges payers face by improving member care, managing rising healthcare costs, improving Centers for Medicare and Medicaid Services Star Ratings, increasing member engagement, and reducing hospital readmissions. Digital health solutions provide tools that enable payers to address concerns such as social determinants of health (SDOH) by improving access to care while minimizing costs. The benefits of these solutions extend beyond payers, however. Members also experience the benefits of virtual care solutions.