The release of the 2025 Medicare Advantage and Part D Star Ratings has unveiled a year filled with significant challenges for health plans. Published on October 10, 2024, these ratings reflect a growing difficulty in achieving top-tier scores. With the Centers for Medicare & Medicaid Services (CMS) tightening its performance measures, plans are facing increasing pressure to meet the evolving benchmarks for quality care and member experience.

The 2025 Star Ratings predominantly rely on data from the 2023 measurement year. While Star Ratings are a familiar metric, the results this year reveal a tougher landscape. Several notable shifts in the program’s structure, such as changes to measure weights and updates to the methodologies used to collect data, have contributed to a decline in overall performance. This year's ratings provide insight into where the industry is headed and what health plans must do to adapt.

One of the biggest factors impacting the 2025 Star Ratings is the increasing weight on certain clinical measures. For example, the Plan All-Cause Readmissions measure under Medicare Part C saw its weight jump from 1 to 3, significantly increasing its impact on a plan’s overall rating. At the same time, the Breast Cancer Screening measure transitioned to the Electronic Clinical Data Systems (ECDS) methodology, requiring plans to adjust their reporting systems. These changes were part of CMS’s broader effort to push for more comprehensive and accurate data on health plan performance, but they also posed challenges for many plans that may not have been fully prepared for the shift.

Another area of impact was the addition of web-mode data collection to CAHPS® (Consumer Assessment of Healthcare Providers and Systems) measures, which changed how member feedback was gathered. While most CAHPS measures remained stable, the Getting Appointments and Care Quickly measure saw a notable increase in its cut points, making it harder for plans to perform well in this area. As patient experience continues to be a cornerstone of the Star Ratings program, even minor adjustments in how data is collected can have ripple effects across the industry.

Looking ahead, the upcoming Star Years promise even more changes. For Star Year 2026, several new measures are being introduced, such as the Kidney Health Evaluation for Patients with Diabetes, and existing measures, like Colorectal Cancer Screening, are transitioning to the ECDS format. In addition, the CAHPS and Administrative Patient Experience weights will decrease, from 4 to 2, to allow a more balanced focus across a broader range of measures. This rebalance reflects CMS’s ongoing efforts to fine-tune the Star Ratings program and provide a clearer, more comprehensive picture of plan performance.

For many health plans, the 2025 results may have been disappointing. With increased cut points and more stringent criteria, plans that didn’t adapt quickly to these changes may have seen their Star Ratings drop. However, there are clear pathways forward. For plans looking to improve future ratings, focusing on HEDIS® (Healthcare Effectiveness Data and Information Set) performance will be crucial. HEDIS measures are a central part of Star Ratings, and improving clinical quality will have a direct impact on a plan’s overall score. Additionally, investing in better data collection processes and patient experience programs can help plans position themselves for success in the coming years.

For plans that need guidance after the 2025 Star Ratings release, UST HealthProof’s Star Ratings consulting services offer the expertise needed to drive improvement. With a focus on HEDIS performance and tailored strategies, UST HealthProof can help health plans build a stronger, more competitive Star Ratings program.

Reach out today to learn how we can help your plan achieve its quality goals and succeed in the evolving healthcare landscape.