2025 Medicare Advantage Star Ratings: What Seniors Need to Know and Do

2025 Medicare Advantage Star Ratings: What Seniors Need to Know and Do

The 2024 Medicare Advantage (MA) Star Ratings bring significant changes that seniors need to be aware of when selecting a healthcare plan. For the second year in a row, the ratings have dropped, with the average rating for Medicare Advantage Prescription Drug (MA-PD) plans falling from 4.14 in 2023 to 4.04 in 2024. The number of five-star plans also saw a steep decline, from 57 in 2023 to just 31 in 2024. These shifts highlight the increasing difficulty in achieving top performance ratings, largely due to stricter evaluation criteria and recent methodological changes by the Centers for Medicare & Medicaid Services (CMS)

CMS.gov.

What Are the Star Ratings?

The Star Ratings system is used by CMS to evaluate the quality of Medicare Advantage and Part D plans. Ratings range from 1 to 5 stars, with 5 representing the highest quality. The scores are based on factors such as healthcare quality, customer service, and member experience. These ratings are important because higher-rated plans not only receive bonus payments from CMS but also attract more enrollees, making them a key factor during the annual open enrollment period

Why Are Ratings Declining?

The drop in ratings can be attributed to multiple factors:

• Changes in Evaluation Methodology: The "Tukey outlier deletion" process, introduced this year, altered how performance cut points are calculated, making it harder for plans to achieve high scores even if they showed improvement in individual measures.
• Measure Adjustments: Some existing measures, like Diabetes Care – Kidney Disease Monitoring, were retired, while new measures such as Transitions of Care and Follow-Up for High-Risk Chronic Conditions were added. These changes affected how plans are assessed and impacted their overall scoresCMS.govCertifi.

The Weight of Member Experience

Member experience plays a significant role in the overall ratings. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey heavily influences scores due to its high weighting. Plans that struggled in areas like accessing care quickly or getting needed prescriptions experienced substantial rating declines. These areas are critical for seniors who rely on timely healthcare access

The Impact of Plan Experience

Long-standing plans generally perform better in the ratings. Those with over ten years in the program tend to have the infrastructure and experience needed to meet quality benchmarks consistently. In contrast, newer plans often face challenges in maintaining high ratings due to the evolving requirements and lack of established processes

CMS.gov

What Should Seniors Do?

Given the changing landscape, seniors need to take proactive steps to ensure they choose the right healthcare plan:

1. Review the Latest Star Ratings

   • Check your current plan's rating to see if it has changed. Plans with 4 stars or higher are considered high quality, and if your plan's rating has dropped, it may signal declining service quality or healthcare outcomes.
   • Look at specific measures, such as customer service and chronic condition management, to see how the plan performs in the areas that matter most to you.

2. Assess Your Health Needs

   • Consider your medical conditions and future healthcare needs. If you have a chronic illness, ensure the plan excels in managing such conditions and provides comprehensive access to necessary services.
   • Verify that the plan's drug formulary covers your medications and that preventive services are included.

3. Consult a Medicare Advisor

   • Seek advice from a Medicare expert who can help you understand the ratings and explore alternative plans if your current one no longer meets your needs. The Medicare Trusted Advisors directory is a good place to find local, experienced Medicare Advisors that you can know and they can offer you the best options available for you.

     Look Beyond Star Ratings

     • Although star ratings provide a valuable benchmark, consider other factors such as out-of-pocket costs, network restrictions, and additional benefits like dental or vision coverage. Sometimes, a plan with a slightly lower rating may offer more value in terms of benefits.

4. Use Open Enrollment Wisely

   • The Medicare Open Enrollment Period (October 15 – December 7) is an opportunity to switch to a better plan if you’re unsatisfied with your current coverage. Compare different plans during this period to ensure you get the most appropriate coverage for your healthcare needs and budget.

Conclusion

The 2025 Medicare Advantage Star Ratings reflect a more challenging environment for plans aiming for top performance, but they still offer a reliable tool for comparing healthcare options. By understanding these updates and taking a proactive approach, seniors can choose a plan that provides both quality and value, ensuring their Medicare coverage meets their needs effectively.

Taking these steps will help seniors navigate the 2025 landscape and make informed decisions during the open enrollment period.