Star ratings are critical to Medicare Advantage plans, given their financial and strategic contributions. Despite uncertainty about the impact of the government shut down, the Centers for Medicare & Medicaid Services (CMS) publicly released the 2026 Star ratings data for all contracts on October 9.
After years of consistent Star ratings declines beginning in 2022, Star ratings hit a low point in 2025. This year’s Star ratings show marginal improvement from the nadir but immaterial movement of membership into higher-rated (4+ Star) plans.
While health plans have been able to view their own results in the plan preview period for the past few weeks, stakeholders across the country are now pouring through the data to understand trends and implications.
In this briefing, we share a preliminary analysis of the Star ratings results and rating changes for specific plans.
Star ratings have stabilized following a period of deterioration
Distribution of enrollment by star rating year over year
- This year, 63.5% of membership is attributed to a 4+ Star plan, down slightly from 64.1% the year prior.
- Enrollment in 5 Star plans remains negligible but increased slightly to 2.3% of members, down from its peak of 27% in 2022 but up marginally from 2.0% in 2025.
- Enrollment in plans with less than 3 Stars remained steady at approximately 1%. This is important because plans that score below this threshold in consecutive years cannot market for additional membership or file for new applications or service area expansions (SAEs). They also could be terminated if they have low scores for 3 years in a row.
Largest plans (by enrollment) saw a nominal 0.07 Star rating increase
Average Star ratings changes for top 15 health plans (by enrollment)
(1) Stars performance and membership reflected as Cigna in previous years is now captured under Health Care Service Corporation, reflecting HCSC’s recent acquisition of Cigna’s Medicare Advantage business.
When looking at the top 15 plans by enrollment, notable findings include:
- The market’s average Star rating increased to 3.99 in our enrollment-weighted analysis, which is up slightly from 3.93 last year.
- The largest plans improved their Star ratings 7 basis points, while the rest of the market declined by 2 basis points. This may reflect the advantages of scale for these larger organizations to drive Stars improvement.
- The most significant changes to enrollment-weighted Star ratings for 2026 were:
- SCAN saw an average decline of 0.47, though its average rating remains above 4 Stars.
- HCSC experienced an average decline of 0.30 Stars, and its average rating remains below 4 Stars.
- GuideWell’s (Florida Blue) Star rating increased by 0.30 and is now above 4 Stars.
- United’s average Star rating increased by 0.25 and is now above 4 Stars.
- Centene has continued to improve from its 2023 decline. This year, Centene posted an average 3.39 Star rating, up from 3.14 Stars in 2025 but still down from its peak of 3.89 Stars in 2022.
Shifts in 4+ Star enrollment may impact individual plans’ future positions
Achieving 4+ Stars is critical because it qualifies the health plan for the quality bonus payment (QBP) and a greater rebate percentage.1 The health plan can reinvest both into benefits that make products more attractive, driving growth and financial performance.
The table below shows how membership in the largest 15 health plans (by total enrollment) has shifted into or out of tiers of Stars performance. Looking beyond the average rating to the shifts in tiers reveals the true economic impact for each plan.
Percentage point change in membership (2025 v. 2026) by Star rating tier for top 15 health plans
Note: Bubble size indicates greater percentage change in membership between Star rating tiers.
Some plans experienced significant shifts in their 4 and 5 Star plans. Plans that saw membership shift out of these categories will experience margin pressure due to the loss in QBP. Lifetime Healthcare (Excellus) saw nearly 35% of its enrollment shift from the 4 Star tier into the 3 Star tier. Other plans with significant shifts in membership to plans below 4 Stars include HCSC (-13.2%) and BCBS Michigan (-8.5%).
Humana’s largest contract (H5216) remains below 4 Stars. Earlier this month, Humana indicated they expect most of their members to be enrolled in plans below 4 Stars in 2026.
Other plans experienced more favorable results. GuideWell Health (Florida Blue) shifted nearly 24% of its membership from 3 Star plans to 4 Star plans. Other plans with significant shifts in membership to plans above 4 Stars include Centene (+19.5%) and United (+7.1%).
Additional Contributors: Owen Denn, Consultant
Sources:
1 Centers for Medicare & Medicaid Services (CMS) Medicare Advantage September 2025 Enrollment and 2026 Medicare Advantage Part C and D Star Ratings Data Tables, Chartis analysis.
Enrollment is based on September 2025 CMS enrollment and includes only health plans that had ratings in both 2025 and 2026. Star ratings are weighted by enrollment.
Our analysis bases weighted average enrollment on the most recent enrollment data available for the Star rating year. Thus, our weighted average Stars for previous years will not match the weighted average Stars in the CMS memo.
