Medicare Advantage Star Ratings 2026: Winners, Losers & What Changed

Published July 2026 · 14 min read

How CMS Star Ratings Work

Every year, the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage and Part D plans on a scale of 1 to 5 stars. These ratings are based on over 40 quality measures spanning five categories: staying healthy (screenings and tests), managing chronic conditions, plan responsiveness, member complaints, and customer service.

Star ratings aren't just a report card — they carry real financial consequences. Plans rated 4 stars or above receive quality bonus payments from CMS, typically a 5% increase in their per-member benchmark rate. Five-star plans get an additional 5% bonus and enjoy year-round open enrollment privileges. Plans rated below 3 stars for three consecutive years face termination.

This creates a powerful incentive structure: higher ratings mean more money, which means better benefits, which attracts more enrollees, which generates more revenue. It's a virtuous cycle for top performers — and a death spiral for those at the bottom. For more on how MA compares to traditional Medicare, see our 2026 comparison.

2026 Ratings Overview: The Big Picture

The 2026 star ratings represent a notable correction after years of ratings inflation. The average MA plan rating fell to 3.92 stars, down from 4.04 in 2025 and a peak of 4.15 in 2023. This is the first time the industry average has dipped below 4.0 since 2020.

Several factors drove the decline. CMS tightened the "cut points" — the performance thresholds required to achieve each star level — for multiple measures. The agency also phased out COVID-era guardrails that had protected plans from pandemic-related ratings drops. And new health equity measures, while important for accountability, created additional hurdles for plans that hadn't invested in addressing disparities.

The result: 42 plans dropped by at least half a star, while only 28 plans improved by half a star or more. The number of 5-star plans fell from 17 to 12, and the number of plans rated below 3 stars increased from 41 to 58.

Top 10 Medicare Advantage Plans by Star Rating

Year-Over-Year Rating Changes: Major Insurers

The 2026 ratings shake-up hit some of the industry's biggest players hard, while rewarding plans that invested in quality improvement:

The Winners: Who Improved

Kaiser Permanente continues to dominate the star ratings landscape. Its integrated care model — where the insurer, hospital system, and physician groups are all under one roof — gives it structural advantages in care coordination, preventive care, and data collection that fee-for-service competitors can't easily replicate. Four of its plans earned perfect 5-star ratings in 2026.

UPMC Health Plan and Geisinger Health Plan were the biggest improvers among regional plans, each gaining about a quarter-star across their portfolios. Both are integrated delivery systems based in Pennsylvania that invested heavily in care management, provider engagement, and health equity programs over the past two years.

Several smaller regional plans also outperformed, including Priority Health in Michigan, HealthPartners in Minnesota, and MVP Health Care in New York. The common thread: deep provider relationships, integrated data systems, and a focus on preventive care rather than volume.

The Losers: Biggest Declines

Humana took the biggest hit among national carriers. The Louisville-based insurer, which derives the majority of its revenue from Medicare Advantage, saw its average rating fall from 4.08 to 3.72. Seven of its plans dropped below the critical 4-star threshold, jeopardizing hundreds of millions in bonus payments. Humana attributed the decline to CMS's tightened cut points and the removal of pandemic guardrails.

Centene/WellCare continues to struggle with quality ratings. The Medicaid-heavy insurer has had difficulty translating its Medicaid managed care expertise to the Medicare population. With an average rating of 3.18, several WellCare-branded plans are at risk of CMS sanctions if they remain below 3 stars.

UnitedHealthcare, the largest MA insurer by enrollment, showed mixed results. While some of its plans improved, the portfolio average declined 0.13 stars to 3.81. UHC's massive scale — over 8 million MA enrollees — means even small ratings shifts affect millions of beneficiaries and billions in bonus payments.

The $12.8 Billion Question: Bonus Payments

Star ratings are ultimately about money. In 2026, CMS is distributing approximately $12.8 billion in quality bonus payments to MA plans rated 4 stars or above. These payments are funded by taxpayers and represent a significant revenue stream for high-performing plans.

Plans use bonus payments to fund supplemental benefits that go beyond what Original Medicare covers: dental care, vision exams, hearing aids, gym memberships, meal delivery, and transportation to medical appointments. This creates a compelling value proposition that has driven MA enrollment growth — but critics argue it also means taxpayers are subsidizing benefits that traditional Medicare beneficiaries don't receive.

Regional vs. National: A Tale of Two Models

The 2026 ratings reveal a consistent pattern: regional, integrated plans outperform large national carriers. Among plans rated 4.5 stars or above, 78% are regional or provider-sponsored plans with deep ties to local delivery systems. Among plans rated below 3.5 stars, 65% belong to national insurers.

This isn't a coincidence. Integrated systems like Kaiser, Geisinger, and UPMC control both the insurance and delivery sides, giving them advantages in care coordination, data sharing, and quality improvement that national carriers — which contract with thousands of independent providers — can't easily replicate.

The implication for beneficiaries: if a regional plan with a high star rating is available in your area, it's often a better bet for quality of care than a national carrier's plan — even if the national brand is more recognizable.

How Ratings Affect Premiums and Enrollment

Star ratings create a direct pipeline between quality and market competitiveness. Plans with 4+ star ratings can use bonus payments to lower premiums — in many markets, top-rated MA plans offer $0 premium plans that attract enormous enrollment. In 2026, the average premium for a 4+ star MA-PD plan is $18.50/month, compared to $42.80/month for plans rated below 4 stars.

Enrollment data shows a clear consumer preference for higher-rated plans. Among beneficiaries who switched MA plans during the 2026 Annual Election Period, 68% moved to a plan with a higher star rating. Five-star plans saw enrollment increases averaging 12%, while plans below 3 stars experienced enrollment declines of 8-15%.

With 52% of all MA enrollees now in plans rated 4 stars or above — down from 58% last year — the ratings decline could have real consequences for beneficiary benefits in 2027 and beyond if plans can't recover their performance scores.

What This Means for Beneficiaries

If your Medicare Advantage plan dropped in ratings, watch for changes during the next Annual Election Period (October–December 2026). Plans that lost bonus payments may reduce supplemental benefits, increase cost-sharing, or raise premiums for 2027. Use Medicare's Plan Finder tool to compare star ratings and benefits in your area.

If your plan earned 5 stars, you have the advantage of year-round enrollment — you can switch to that plan at any time, not just during open enrollment. This is one of the most valuable perks of 5-star status, as it gives beneficiaries maximum flexibility.

The Health Equity Factor

One of the most consequential changes in the 2026 ratings cycle is the introduction of health equity measures. For the first time, CMS is evaluating plans on how well they serve beneficiaries across racial, ethnic, and socioeconomic lines — not just their average performance.

Plans receive credit for reducing disparities in clinical outcomes between demographic groups. For example, a plan that achieves similar diabetes control rates across white, Black, and Hispanic enrollees scores higher than a plan with a high overall average but significant gaps between groups.

This has created winners and losers. Plans with diverse enrollment populations that have invested in cultural competency, community health workers, and social determinants of health interventions — like food insecurity screening and transportation assistance — are being rewarded. Plans that focused exclusively on their healthiest, most engaged members are seeing their ratings decline.

The industry response has been mixed. Some insurers have embraced health equity as both a moral imperative and a business opportunity. Others have complained that the measures are poorly defined, that data collection is inconsistent, and that plans serving disadvantaged populations are being penalized for factors outside their control.

What Medicare Beneficiaries Should Do

Star ratings are one of the most useful tools available to Medicare beneficiaries when choosing a plan. Here's how to use them effectively:

• Check your plan's rating at Medicare.gov/plan-compare — ratings are updated every October
• Look beyond the overall rating — examine individual measure categories to see where your plan excels or struggles
• Compare plans in your area — you may find a higher-rated plan with similar or better benefits at the same cost
• Watch for benefit changes — plans that lost bonus payments may reduce supplemental benefits for the next plan year
• Consider switching during AEP — the Annual Election Period (Oct 15 - Dec 7) is your opportunity to move to a higher-rated plan
• Five-star plans offer year-round enrollment — if a 5-star plan is available in your area, you can switch at any time

The Bigger Picture: Are Star Ratings Working?

CMS designed the star rating system to drive quality improvement through financial incentives. By that measure, it has been a qualified success — average ratings have risen over the past decade, and plans have invested significantly in quality improvement programs, care coordination, and member experience.

But critics argue the system has also driven gaming behavior. Some plans have focused on optimizing specific measures rather than genuinely improving care. Others have used marketing and enrollment strategies to attract healthier members who are easier to score well on. And the concentration of bonus payments among a shrinking number of top performers raises questions about whether the system rewards excellence or just scale.

The 2026 ratings correction may ultimately prove healthy for the program — a recalibration that separates genuine quality leaders from plans that benefited from pandemic protections and ratings inflation. But the transition will be bumpy, and millions of beneficiaries may see their benefits affected in the process.

Looking Ahead: 2027 Methodology Changes

CMS has signaled further methodology changes for the 2027 ratings cycle, including increased weight on health equity measures, new behavioral health quality metrics, and revised patient experience survey questions. Plans will also face new requirements around provider directory accuracy and prior authorization transparency — two areas where beneficiary complaints have surged.

For the MA industry, the message is clear: the era of easy high ratings is over. Plans that invest in genuine quality improvement and health equity will be rewarded; those that relied on gaming metrics or pandemic protections will face a reckoning.