The decline in Medicare Advantage Star Ratings presents a significant challenge for health plans. Only 62% of Medicare Advantage members are in plans rated four stars or higher for 2025. This marks the lowest percentage in nearly a decade, signaling a need for health plans to focus on improving member engagement and outcomes.
In this blog post, we’ll explore what Medicare Star Ratings are, how they are calculated, and why they matter for Medicare Advantage plans. We'll also take a look at how implementing comprehensive Medicare health and wellness programs can help reverse the decline in these ratings, driving member satisfaction and improving health outcomes.
What are Medicare Star Ratings?
Medicare Star Ratings are a system used by the Centers for Medicare & Medicaid Services (CMS) to measure the quality of health plans within the Medicare program. These ratings evaluate plans based on various factors like patient care, member satisfaction, and plan services, giving a score from one to five stars.
Medicare Star Ratings are crucial for both Medicare beneficiaries and health plans. For beneficiaries, higher-rated plans are often seen as a sign of quality, and many members will choose to enroll in plans with better ratings. For health plans, achieving high Star Ratings can mean increased plan enrollment and higher government funding.
How Are Medicare Star Ratings Calculated?
Medicare Star Ratings are based on several key categories, including:
- Clinical Quality Measures: These include metrics like how well a plan manages chronic conditions, preventive care, and hospital readmission rates.
- Member Satisfaction: This category is assessed through surveys such as the Consumer Assessment of Healthcare Providers and Systems (CAHPS), which measures how satisfied members are with their plan’s service, care, and support.
- Customer Service: How efficiently a plan handles member inquiries, complaints, and issues is an important metric.
- Health and Wellness Programs: This includes the availability of preventive services, wellness programs, and disease management initiatives.
- Drug Plan Performance: For Medicare Advantage plans that offer prescription drug coverage, how well they manage prescription drug use is also part of the calculation.
Each of these areas receives a score, and the final Star Rating reflects overall performance. Members consider plans with a rating of 4 stars or higher to provide a high-quality experience. However, with the recent decline in Medicare Advantage Star Ratings, it’s clear that many plans need to reevaluate how they are engaging with members and delivering quality care.
Related: Building Better Senior Fitness Benefits in Medicare Advantage Plans
Why Are Star Ratings Important to Medicare Advantage Plans?
Star Ratings play a crucial role in the financial health of Medicare Advantage plans. The higher the Star Rating, the better the funding a plan receives from CMS. In fact, Medicare Advantage plans with a rating of 4 stars or higher are eligible for quality bonus payments, which can significantly enhance a plan’s revenue.
Star Ratings also impact marketing efforts and plan enrollment. Medicare beneficiaries are more likely to select plans with higher Star Ratings, as they associate them with better quality care and customer service. If a plan's ratings decline, it risks losing members to competitors with higher ratings, directly impacting its bottom line.
Plans that receive a low Star Rating may face penalties or reduced government funding, which makes it even more critical for these plans to focus on improving the quality of care they provide to members.
Related: What do Seniors Want in their Medicare Plan?
How Medicare Health and Wellness Programs Can Help
The Medicare Advantage Star Ratings system has shifted its focus to reward plans that provide holistic care that emphasizes prevention and wellness. As Star Ratings for Medicare Advantage plans decline, it's crucial for plans to adopt comprehensive health and wellness programs that can engage members and improve health outcomes.
Medicare health and wellness programs that offer fitness classes, nutrition counseling, and disease management programs are powerful tools that can directly affect several Star Rating measures. They can also help reduce hospital readmissions, improve the management of chronic conditions, and increase preventive care uptake—key areas evaluated in the Medicare Star Ratings system.
FitOn Health’s comprehensive solution is designed to address the unique needs of Medicare members, offering personalized, comprhesnive support that includes:
- Custom fitness programs tailored to members' individual health goals and needs.
- Mindfulness and stress management resources that improve overall well-being.
- Nutrition counseling to support healthy eating and weight management.
- Educational content and community support that empowers members to take charge of their health.
Medicare Advantage plans that offer health and wellness programs can help members improve their health, increase satisfaction, and boost their Star Ratings. Plus, plans with personalized, engaging wellness options are more likely to keep members around and draw in new enrollees looking for top-notch, supportive care.
Related: The Link Between Physical Activity and Senior Mental Health
The Path Forward: Download the Full Guide
With the decline in Medicare Advantage Star Ratings posing a serious challenge, health plans must prioritize the improvement of their member engagement and wellness offerings. Implementing a robust Medicare wellness program is one of the most effective strategies to boost Star Ratings, enhance member satisfaction, and achieve long-term success.
To learn more about how you can improve your Medicare Advantage Star Ratings, download our guide: Boost Your Medicare Star Ratings With FitOn Health: A Proven Path to Member Engagement. This resource outlines practical steps, strategies, and examples to help you optimize your wellness programs and meet CMS's quality expectations.
Download the full guide now and start improving your Medicare Star Ratings today!
