In the realm of Medicare Advantage (MA) plans, the 2026 star ratings have generated significant interest among major insurers. The latest report from the Centers for Medicare & Medicaid Services (CMS) indicates that average star ratings remain stable, showing slight improvement from 3.96 to 3.98.
2026 Medicare Advantage Star Ratings Overview
The CMS released the 2026 star ratings amid concerns over declining quality scores in previous years. While the overall ratings show a minor uptick, the performance of individual insurers varied dramatically.
Key Players and Their Ratings
- UnitedHealthcare: More than 77% of members will be in plans with 4 stars or higher, maintaining its performance from the previous year.
- Humana: Approximately 20% of its members will be in highly rated plans, down from 25% in 2025.
- Aetna: About 81% of its 4.2 million members will be in plans rated 4 stars or more, although this is a decline from 89% in 2025.
- Elevance: 53% of its 2.2 million members will have plans rated at least 4 stars, improving from around 40% this year.
- Centene: The percentage of its members in highly rated plans surged from 1% to over 18% next year.
- Clover Health: The insurer saw its largest contract drop below the 4-star threshold, potentially affecting its earnings detrimentally.
Impact of Star Ratings on Insurers
The star ratings are crucial for insurers because they directly influence bonus payments and competitive positioning in the MA program. Plans rated at least 4 stars typically receive increased funding, which can enhance their service offerings.
Despite the minor rise in average ratings, fluctuations among major players have led to concerns. Clover Health’s decline below the 4-star level for its principal contract, which covers nearly all its members, could lead to significant financial repercussions.
Industry Concerns and Future Outlook
As analysts highlighted, the results were largely as expected, with no significant surprises barring Clover’s outcome. The financial environment remains challenging for insurers, with rising healthcare costs and regulators tightening reimbursement policies. Given these pressures, many major carriers are reevaluating their market strategies.
Insurers like Humana are already focusing on contract diversification to optimize their member enrollments and boost revenues in upcoming years. As the 2026 ratings reflect both opportunities and challenges, stakeholders in the Medicare Advantage sector will need to adapt swiftly to maintain their market positions.
