Medicare Advantage Stars: What’s next now that the litigation floodgates have opened?

Lexology January 8, 2025
Reed Smith LLP

For years, Medicare Advantage (MA) plans went through the process of receiving their Star Ratings, generally accepting them and moving on to the next year. However, in recent years, CMS has systemically tweaked the ratings methodology with the stated purpose of driving down the Stars Ratings and the corresponding quality bonus payments.

CMS’s drag on ratings has resulted in a consistent decline of Star Ratings across the country, straining plan revenue and threatening member benefits. Starting in late 2023, plans went on the offensive against CMS, with Elevance and SCAN Health leading the charge, suing CMS under the federal Administrative Procedures Act for violating its own regulations in calculating Star Ratings. The result was a significant legal victory for the...

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