The Centers for Medicare and Medicaid Services is focused on continuing to improve the quality of Part D and Medicare Advantage plans. The Star Ratings system helps beneficiaries and their caregivers compare Medicare health and drug plans and make the best decisions. Every year CMS publishes the Star Ratings to give beneficiaries and their caregivers meaningful information about quality, benefits and costs.
Earlier this month, CMS published the 2025 ratings. The press release noted that, to achieve a high star rating, Medicare Advantage plans will need to do a better job.
CMS noted:
- About 40% of the 2025 MA-PD plans (Medicare Advantage plan with prescription drug coverage) earned four stars or higher, and
- Just over 60% of enrollees will be in a plan with four or more stars.
That sounds pretty good but let’s dig a little deeper.
At the height of the COVID pandemic, CMS relaxed the way it calculated quality ratings. The result: An increase in star ratings led to plans receiving bigger bonus payments. Plans could use these payments to offer supplemental benefits, reduce cost sharing, and lower Part B and Part D premiums. Plans with a 4+ rating received approximately $350 per member, with CMS paying out over $10 billion in quality bonuses in 2022. Plans weren’t necessarily providing more quality services; CMS was just grading on a curve.
Then, in 2023, many of the COVID-19 pandemic era policies expired. CMS started tightening the criteria which was followed by a noticeable drop in quality.
- Three years ago, just about 90% of enrollees were in a plan with four or more stars (compared to 60% in 2025).
- There were 74 5-star plans or 27% of the contracts in 2022 and, in 2025, there will be only seven, 1.3%.
- Those seven are regional and don’t include any so-called BUCA plans (Blue Cross, Unitedhealthcare, Cigna and Aetna). Enrollments in six of those plans range from 6,200-78,000; the seventh is in Puerto Rico, with 284,000 enrollees.
- The number of plans receiving 2 or 2.5 stars (the other end of the quality spectrum) increased from two (0.03%) in 2022 to 24 (4.6%) in 2025.
- In 2024, the drop in quality reduced bonus payments by $1 billion, to $11.8 billion. That’s still a significant amount but these reduced payments will likely lead to changes in 2025 plans, such as higher premiums, copayments, and deductibles, as well as reduced coverage.
Here’s What Medicare Advantage Enrollees Should Do
If benefits are important, dig into the details.
- Review your plan’s summary of benefits and Evidence of Coverage to determine what’s changing for any benefits. For example, one plan has a $3,000 dental benefit but will pay only 50% for dentures.
- Check out the network for benefit providers. A friend recently was disappointed to learn that her favorite vision provider will not be in her plan’s network next year.
If you’re concerned about quality, study the star ratings.
- Realize that you may see a decline in the number of stars plans receive.
- Find the star ratings at the bottom of the plan details page in the Plan Finder and click on “Expand All Ratings.”
- For the health plan, focus on “Member experience with health plan,” that includes “Getting appointments quickly,” “Ease of getting needed care and seeing specialists,” and other members’ ratings, “Customer service” along with any area of concern, such as “Reducing blood pressure” or “Osteoporosis management.”
- For the drug plan, review “Customer service,” “Member experience” and “Ease of getting prescriptions filled.”
Open Enrollment is a most important time for Medicare beneficiaries, especially those with Medicare Advantage. Take time to check out costs, networks, and medical services and benefits. If you don’t, your 2025 Medicare quality experience may not be five-star.