Medicare Advantage star ratings under scrutiny as challenges from payers mount

Becker's Healthcare October 18, 2024
Rylee Wilson

Several insurers are disputing CMS’ Medicare Advantage star ratings.

For 2025, just seven plans received a five-star rating from CMS, down from 38 in 2024. The overall average rating was 3.92, down from 4.07 the previous year.

On an Oct. 17 earnings call, Elevance Health CEO Gail Boudreaux said the company will see the number of members in plans rated four stars or higher decline, due to one of its larger contracts missing a four-star rating by 0.0004 of a point.

“We have challenged our initial scoring with CMS, and are considering all our options,” Ms. Boudreaux said.

Medicare Advantage plans are rated on 40 clinical quality and member service measures, and determine how much plans receive in bonus payments...

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