If you’ve spent any time looking at Medicare Advantage plans lately, you’ve probably seen those little gold stars next to the names. Most people assume they’re just like Yelp reviews—basically, how much other seniors liked the plan. But honestly, that is probably the biggest thing people get wrong. Those stars are actually a high-stakes financial scoreboard that dictates how much extra money your insurance company gets from the government.
Right now, medicare advantage star ratings news is making waves because the 2026 data just dropped, and it's a mixed bag of stabilization and quiet desperation for some big-name insurers. After years of ratings falling off a cliff, things are finally starting to level out, but the "gold rush" era of easy 5-star ratings is definitely over.
The 2026 Scores Are In (and They’re Kind of Flat)
The Centers for Medicare & Medicaid Services (CMS) just released the numbers for the 2026 performance year, and the average score sits at about 3.99. That’s a tiny nudge up from last year’s 3.93. On the surface, it looks like the industry is recovering.
But look closer.
Only about 40% of plans actually hit that 4-star threshold. Why does that number matter? Because 4 stars is the "magic number" where the government starts cutting bonus checks. If a plan hits 4 stars or higher, they get a 5% quality bonus payment (QBP). If they hit 3.5 stars, they get zero. Zip. Nada.
For a giant like Humana, the news has been pretty brutal. They’ve been vocal about the fact that a huge chunk of their members—around 80%—will be in plans rated below 4 stars for 2026. Compare that to Aetna (CVS Health), where over 80% of members are in plans that actually made the cut. This isn't just a pride thing. We are talking about billions of dollars in funding that won't be there to pay for your dental, vision, or $0 premiums.
Why Did the Stars Fall Anyway?
You might be wondering why everything started tanking a couple of years ago. It’s mostly because CMS changed the "math" behind the scenes. They started using something called the Tukey Outlier Deletion.
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Basically, it's a statistical trick.
CMS decided to stop counting the absolute worst-performing plans when they calculate the average. By removing those "outliers," the bar for everyone else got much higher. It’s like a teacher deciding not to grade on a curve anymore because the failing students were making the B-students look like geniuses.
Suddenly, plans that were coasting at 4 stars found themselves dropped to 3.5 because the "average" they were being measured against became much tougher to beat.
Then you’ve got the lawsuits. UnitedHealthcare actually sued CMS—and won—over a single "secret shopper" phone call. A CMS tester called their customer service line, the call got disconnected after eight minutes, and CMS used that one failed call to tank their rating. A judge in Texas called that "arbitrary and capricious." Now, CMS has to recalculate those scores, which could put millions of dollars back into United's pockets.
What Most People Get Wrong About the 5-Star Icon
If you see a plan with a "High Performing" icon (the 5-star badge), you have a special superpower. You can switch into that plan any time of year, not just during the fall Open Enrollment.
For 2026, only 18 contracts earned that perfect 5-star rating. That’s up from only seven last year, but it's still way down from the 38 we saw back in 2024. Devoted Health was one of the big winners here, snagging three separate 5-star ratings.
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On the flip side, if you see a "Low Performing" icon—a little warning sign—it means that plan has stayed below 3 stars for three years in a row. CMS eventually gets tired of bad performance and will actually kick these plans out of the program if they don't fix things.
New Rules for 2026: The "Vibe" Shift
CMS is changing how they weigh different categories. For 2026, they are actually lowering the importance of "Patient Experience" (CAHPS) surveys. Previously, these surveys—which ask things like "how easy was it to get an appointment?"—counted for a massive chunk of the score.
Now, they are cutting that weight in half.
The focus is shifting back to clinical outcomes. They’re adding new measures, like Kidney Health Evaluation for Patients with Diabetes. They’re also putting more weight on how well a plan manages a member's physical and mental health over time.
Essentially, CMS is saying: "We don't just care if the customer service rep was nice; we care if your blood pressure is actually under control."
The Real Impact on Your Benefits
When you see medicare advantage star ratings news about a plan losing its 4-star status, you should check your mailbox.
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Insurers use those bonus payments to "buy down" your costs. If the bonus disappears, the money has to come from somewhere. Usually, that means:
- Your "Over-the-Counter" (OTC) card monthly balance gets smaller.
- Your dental coverage goes from "comprehensive" to "preventative only."
- Your maximum out-of-pocket limit goes up from $3,500 to $6,000.
It’s a chain reaction. Poor stars lead to less money, which leads to worse benefits, which often leads to unhappy members leaving the plan.
How to Use This Information Right Now
Don't just pick a plan because it has a 4.5-star rating today. Look at the trend. If a plan has gone 4.5 -> 4.0 -> 3.5, they are struggling to keep up with the new, tougher standards.
Here is what you should actually do:
Check the "Plan Finder" tool on Medicare.gov specifically for the 2026 star ratings. Look at the "Category" ratings. If you have a specific chronic condition, like diabetes, look at how they score on "Chronic Care Management" rather than just the overall score.
Also, keep an eye on your plan's "Annual Notice of Change" (ANOC). If your plan’s stars dropped this year, you’ll likely see the "benefit trim" show up in that document. If the dental or vision perks you rely on are being gutted, it’s probably because your plan lost its quality bonus.
The star ratings aren't just badges; they are the fuel that keeps the "extra" in Medicare Advantage. When the fuel runs out, the perks go with it.
If you're currently in a plan that dropped to 3 stars, it might be time to shop around. There are plenty of regional and "provider-sponsored" plans (those run by local hospital systems) that are actually outperforming the giant national insurance companies right now. Sometimes, staying local is the best way to keep those gold stars—and your benefits—intact.