Under recent data released by the Centers for Medicare and Medicaid Services (CMS), roughly 405 of Medicare Advantage (MA) plans with prescription drug coverage will earn at least four stars in 2025, a slight decrease from the 42% that earned four or more stars in 2024. This figure has been steadily decreasing, with 51% of plans earning four or more stars in 2023 and 68% of plans in 2022.
MA plans with prescription drug coverage are rated on up to 40 unique quality and performance measures. Each of the measures has a threshold established by CMS (known as a “cut point”) that is used to determine whether the contract’s performance for that measure receives a 1-, 2-, 3-, 4-, or 5-star rating. While there were no major methodological changes in the 2025 Star Ratings, there were some minor changes and the changes that CMS made to the methodology that impacted the 2024 Star Ratings had a continued impact on the 2025 Star Ratings.
CMS noted that cut points are recalculated annually, based on performance during the measurement period, and that many of the measure-level cut points increased from the 2024 Star Ratings. This meant that contracts needed to obtain higher performance on select measures to receive a high Star Rating.
Only seven MA contracts with drug coverage earned five stars for 2025, a marked decrease from the 38 that received five stars in 2024. On the other end of the spectrum, eight plans are identified as consistently low performing plans, an increase from six plans this year.
CMS notes that a total of eleven contracts received five stars in 2025: the seven MA with prescription drug coverage mentioned above, two 1876 Cost Contracts, and two are prescription drug plans (PDPs). Ten of the eleven contracts also received five stars in 2024. There are eight contracts on the Medicare Plan Finder with a low performing icon for 2025 for consistently low ratings, seven are MA-PD contracts and one is a PDP.
Humana Sues HHS
In response to the drop in its MA star ratings, and in addition to appealing to CMS, Humana filed a lawsuit against the Department of Health and Human Services (HHS), alleging that the agency is acting in an arbitrary and capricious manner when calculating 2025 Star Ratings for the insurer. Humana is asking the federal judge to vacate the Star Ratings and recalculate the ratings by mid-December so the payer could factor changes into plan bids for the 2026 contract year.
Humana’s average star rating fell from 4.37 in 2024 to 3.63 in 2025. About one quarter of Humana’s MA members will be in a plan with at least four stars next year, a drastic change from the 94% of members who were in a plan with at least four stars in 2024. Analysts have estimated the decrease in Star Ratings may cost Humana as much as $1 to $3 billion in 2026.
UnitedHealthcare Sues HHS
UnitedHealthcare companies also filed suit against HHS related to the significant decrease in Star Ratings. UnitedHealthcare specifically emphasizes one metric – the performance of the call center customer service – as being downgraded based on an “arbitrary and capricious” assessment of just one phone call that “lasted less than ten minutes.” The insurer contends that was what caused it to earn a four-star rating on the call center measure instead of a five-star rating.
UnitedHealthcare alleged that the test caller from CMS failed to ask the required introductory question, and therefore, never received the required response. UnitedHealthcare has previously asked for the call to be invalidated, and in fact, CMS did agree to invalidate two other calls that were in question, but upheld the call that is the focus of this lawsuit.
UnitedHealthcare stated that the decrease in Star Ratings will “misinform millions of current and potential customers” and steer them from choosing a UnitedHealthcare plan.