Bonus: Star Ratings Industry Report 2026

The 2026 Medicare Advantage and Part D Star Ratings are out—and they reveal more than just who earned 5 stars. Beneath the numbers lies a clear message: CMS is reshaping what quality means, shifting the balance from member satisfaction to measurable outcomes and data precision. Plans that once thrived on experience scores are now facing tougher cut points, new ECDS-only measures, and the rise of HOS as a major performance driver.

This episode unpacks what changed, why it matters, and what payers must do now to avoid being left behind. Listen to uncover the real story behind the 2026 Star Ratings—and what it signals for 2027 and beyond.

Host: This week, we’re talking about the 2026 Medicare Advantage and Part D Star Ratings, released on October 9, 2025. It’s the time of year when CMS shows us how plans are performing, and what to expect for the next cycle.

The results are based on 2024 performance data and give us a snapshot of how well health plans are performing on outcomes, member experience, and data integrity.

Joining me today is Shelby Jansen, Manager of Quality, Stars and Strategy, Registered Health Information Administrator. Shelby has deep expertise in guiding payer quality strategies to meet CMS expectations, reflecting NCQA updates, optimizing Stars and HEDIS programs, and guiding health plans through digital transformation. Welcome Shelby.

Shelby: Thanks, happy to be here. Star Ratings season is always an exciting time of year. Some plans get to celebrate, and others head back to the whiteboard.

Host: Shelby, let’s start with a performance snapshot of 2026 Star Rating results?  

Shelby: Sure. So overall, 207 contracts achieved 4 stars or higher in 2026, which represents about 64% of all Medicare Advantage membership. This is roughly consistent with last year’s performance. There was a net decrease of two contracts in the 4+ Star category compared to 2025, 209 down to 207. But the real story is in the distribution of these contracts. We saw 18 contracts earn 5-Stars. This is up significantly from only seven 5-Star plans last year, but still much lower than the 38 we saw in 2024. Membership in those top-rated plans increased slightly from 1.8% to 2.4%. So only a modest uptick. But it shows there’s still some concentration of excellence.

Host: So the overall averages are creeping up, but it’s not like everyone’s back at 4.5-Star territory yet.

Shelby: Exactly. In fact, the average enrollment-weighted Star Rating rose slightly from 3.92 to 3.98. So, there was a small rebound, but the system hasn’t recovered to pre-pandemic highs. We also saw membership movement that tells a bigger story: about 6 million members were in contracts that declined, 7.4 million were in plans that improved, and around 20 million members saw no change. Interestingly, no large contracts with more than 350,000 members moved above or below the 4-star threshold.

Host: So the big players held steady, while smaller or mid-size contracts saw more volatility?

Shelby: Right. And speaking of top performers, Devoted Health and Elevance Health each had three 5-Star contracts, maintaining their reputation for consistency. Alignment Healthcare had two plans, focusing on senior-driven markets, and both UnitedHealthcare and Longevity Health had two plans as well. Then we saw single 5-Star contracts from Independent Health, Leon Health (LMC), MCS Classicare, NHC Advantage, Georgia Health Advantage, and Texas Independence Health Plan. So, still some regional bright spots, especially for ISNP and senior-focused plans.

Host: And what about the plans that rated in the middle tier, like 4 and 4.5-Star plans?

Shelby: That’s a good question. 4.5-Star contracts dropped from 86 to 73, so that’s a loss of 13. But interestingly, membership share grew from 28.9% to 35.7%. That means even though there are fewer contracts, more people are in those high-performing plans. 4-Star contracts held steady at 116, but membership declined from 31.5% to 26.2%. Below that, about 35% of members remain in plans rated under 4-Stars. The 3.5-Star category continued its growth trend. 175 plans this year, which shows many contracts hovering just below the bonus threshold. And then the 2.5-Star contracts dropped from 23 to 21, with membership falling from 1% to 0.5%. Finally, 2-Star contracts doubled from 1 to 2, but they still make up less than one percent of total enrollment.

Host: It’s looking like there’s a little more stability this year than in previous years where we saw a steady decline across plans. What do you think?

Shelby: I agree with you. We’ve seen a broad decline since about 2022 where the average Star Rating across all plans went from 4.37 in 2022, to 4.07 in 2024, to 3.92 in 2025. So 2026 is the first year we’ve seen that stabilize, maybe even recover slightly.

Host: Shelby, what contributed to the average Star Rating decline over the past few years?

Shelby: There were a number of factors that pressed on plans from rising cut points after the COVID era, methodology changes, like the Tukey outlier, and cut-point guardrails, there were a number of market exits by low-performing plans, and probably the biggest factor coming is the ECDS transition.

The 2026 ratings mark the first full year where Colorectal Cancer Screening moved to ECDS-only, retiring hybrid reporting entirely. This is causing some turbulence. Plans that weren’t fully ready for electronic capture saw their rates, and therefore their Star levels dip, even if their clinical care hadn’t changed. It wasn’t about quality of care; it was about inadequate data capture. In a system designed to be more rigorous, data integrity is critical to maintaining high ratings. By 2030, hybrid reporting will be gone altogether. Plans should definitely be keeping this in the forefront and preparing.  

Host: How is the hybrid reporting change affecting plans?  

Shelby: So, for example, consider a plan that has a strong record retrieval outreach program and a strong nurse abstraction team. They conduct in-house retrieval and other initiatives that have historically improved their colorectal cancer screening rates. If this team is still identifying colorectal screening during hybrid review, they need to develop a strategy to capture that data in structured fields because those screenings will no longer be reportable through the hybrid review. A plan like this must collaborate with providers to improve their EHR documentation and implement a robust data acquisition strategy and governance strategy.  

Host: That’s a good illustration of where Star Ratings are heading. So it means plans have to excel in both data readiness and clinical excellence. Shelby, I’m curious, when you first saw the Star Ratings, what stood out to you?

Shelby: What I first noticed was the redistribution of weights. Patient experience and access measures dropped from four times the weight down to two. At the same time, outcome measures like controlling blood pressure and medication adherence carry three times the weight. So, CAHPS and operations measures are more evenly distributed. This is a philosophical shift. So, CMS is signaling to us that what matters most includes now both how the members feel about their care, as well as their health outcomes are improving.

Host: So if plans relied on CAHPS as a safety net, that’s not going hold anymore.  

Guest: Exactly. And we also saw the new HOS measures come in, Improving or Maintaining Physical and Mental Health. They only count as one-times weight this year, but in 2027 it jumps to three times. That’s going to be a game-changer because this change in HOS contribution increased from 7% to 12%.  

Host: Wow. That’s big. Let’s talk about the elephant in the room.  

Shelby: You mean, cut points.

Host: Mm. Hmm.

Shelby: Yes, cut points reflect industry-wide performance shifts. If cut points increased, it means the bar was raised due to better overall performance. It could also be due to the elimination of low-performing contracts due to Tukey, which raised the bar overall. If cut points decreased, it may indicate performance challenges across the board. In the case of colorectal cancer screening, the elimination of hybrid reporting could lead to lower overall performance. And if unchanged, it suggests stability in performance expectations. And that’s what we saw in measures like Colorectal Cancer Screening, where the move to ECDS could cause lower overall performance. A hypothetical example of this situation would be if Controlling High Blood Pressure cut points moved from about 85% to 88% for a Star threshold. This would indicate that the bar keeps rising for clinical outcomes. This means plans have to perform better to maintain the same Star Rating. And another change in Star Year 2026 is that the Health Equity Index has been replaced by EHO4-ALL. This is a new equity-focused measure, but it has a lot of synergies with the Health Equity Index. All of these shifts make it clear, plans that haven’t aligned around holistic member journey will fall behind.  

Host: Looking ahead to 2027, tell us what plans can expect and should be preparing for.

Shelby: Absolutely. For Star Year 2027, HOS measures jump to 3x the weight, so member-reported health becomes a huge driver. HEDIS Hybrid will sunset by 2030, which means plans should be preparing for a full ECDS transition now. There are also new pharmacy measures, things like Concurrent Use of Opioids and Benzodiazepines and Polypharmacy Use of Multiple Anticholinergics, these are a 1x weight. On the clinical side, COA Functional Status Assessment is new, and Colorectal Cancer Screening expands to ages 46–49. EED, also known as the Eye Exam for Diabetes, moves to admin-only, removing the hybrid option, and SUPD adds a statin intolerance exclusion. And even further out, for Star Year 2028, there’s talk of temporarily reducing the risk adjustment weight for medication adherence and possibly eliminating the inpatient/SNF adjustments. None of that’s finalized yet—but it’s on the radar.

Host: After analyzing the 2026 Star Ratings, what do you see as the key elements in this next year’s Star strategy?

Shelby: Measurements keep evolving. What works one year may not translate to the next. And the timeline is unforgiving. Plans have maybe 12 months to respond to changes that can alter their Star trajectory for years. 2026, is about weight changes. For 2027, HOS measures matter even more. And by 2030, the hybrid methodology is gone altogether. Plans need to stop asking, “How do we chase Stars this year?” and start asking, “Do we have a sustainable strategy for data and outcomes over the next five years?” That’s the long-term lens. In the short term, I’d highlight three things. Invest in ECDS readiness. Plans that aren’t working with providers on structured data capture are already behind. So, ECDS needs to become a priority. Then, HOS strategy needs attention. Don’t wait until it’s too late. The weight is tripling, and member perceptions of physical and mental health are harder to influence than lab values, so start now to get the results you want later. But, plans also need to balance experience with outcomes. CAHPS is still weighted, but not enough to carry the rating on its own. Plans need to drive clinical outcomes through integrated engagement, data, and care coordination. And it’s not about buying every so-called cutting-edge new tool. It’s about aligning your operations, technology, and provider partnerships around what CMS will actually measure in 2027 and beyond.

Host: Shelby, thanks so much for joining us and sharing your Star strategy insights.

Guest: Thanks so much for having me. It’s important that plans view the Star Ratings release as more than a report card, it’s really a guide for their future strategy.

Host: That’s a great insight. Thanks to our listeners for making our show possible. If you liked this episode, follow on Apple or Spotify, and share it with your colleagues on LinkedIn.