What to Know About 2025 Medicare Advantage Star Ratings

The 2025 Medicare Advantage Star Ratings highlight a shifting landscape for health plans, with an increased emphasis on patient-reported outcomes and quality of care. Innovative solutions, such as at-home health testing, play a vital role in helping health plans meet and exceed performance benchmarks. Here’s an overview of the latest ratings, comparisons to previous years, and strategies to improve scores.

What Are Star Ratings?

Medicare Advantage Star Ratings evaluate health and drug plans on up to 40 unique measures across multiple dimensions, including member satisfaction, quality of care, and service access. Ratings range from 1 to 5 stars and directly impact reimbursement, enrollment opportunities, and member retention.

Star ratings were developed by the Centers for Medicare & Medicaid Services (CMS) to help Medicare members effectively and easily compare the quality of Medicare health and drug plans. The higher the rating, the better quality the health plan is.

Why Medicare Advantage Star Ratings Matter

Medicare Advantage has steadily grown over the past decade and now encompasses more than half of all seniors eligible for Medicare (KFF, 2024). These ratings have significant implications for health plans:

• Financial Impact: In 2024, health plans received at least $11.8 billion in bonus payments tied to quality scores (KFF, 2024). Plans earning 4 or more stars qualify for these bonuses, enhancing their financial stability and growth potential.
• Enrollment and Retention: Plans with higher star ratings benefit from year-round enrollment opportunities, boosting member acquisition. Additionally, higher ratings are linked to improved member retention, as beneficiaries are more likely to stay with plans offering superior quality and service.

Key Highlights of the 2025 Star Ratings

• Decline in High Ratings: A noticeable drop in the number of plans earning 4 or more stars reflects stricter benchmarks from CMS (Fierce Healthcare, 2025). This trend underscores the increasing difficulty for plans to achieve top-tier performance.
• CAHPS Measures: Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures remain a critical component of ratings. These surveys assess patient experiences with access, communication, and care coordination (AHRQ, CAHPS).
• Preventive Care Gaps: Many plans continue to struggle with preventive care measures, a critical area for improving overall ratings.
• Reducing Health Disparities: CMS’s Framework for Health Equity highlights their commitment to inclusive care. This includes improving access for underserved populations and addressing social determinants of health (CMS Health Equity Framework).

Comparison to Previous Years

Compared to 2024 star ratings and other previous years, the 2025 ratings indicate a growing challenge for plans to maintain high scores. Stricter criteria, combined with an increased focus on patient-reported outcomes, means health plans must adopt proactive strategies. Solutions like at-home health testing can make a measurable difference, helping plans close care gaps, improve health care access, and enhance member satisfaction.

Strategies to Improve Star Ratings

• Focus on Preventive Care: Strengthening preventive care efforts can address critical gaps and contribute to improved ratings. By prioritizing screenings, immunizations, and early interventions, plans can enhance health outcomes and meet CMS benchmarks.
• Enhance Member Engagement: Fostering better communication and engagement with members can lead to higher satisfaction and improved survey results. Providing clear information and support empowers members to actively participate in their care.
• Optimize Chronic Condition Management: Proactive management of chronic illnesses can significantly impact performance metrics and health outcomes. Coordinated care plans and regular follow-ups ensure members receive the support they need to manage their conditions effectively.
• Address Health Disparities: Implementing initiatives to reduce inequities in care delivery helps align with CMS’s health equity priorities and boost ratings. Tailored programs for underserved populations can bridge gaps and promote more inclusive healthcare access.

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Transform Star Ratings with Ash

• Improving Access to Preventive Care: At-home health testing solutions empower members to easily complete screenings for diabetes, colorectal cancer, kidney health, and other quality measures—all from the comfort of their homes. These services not only improve care access but also reduce barriers that might prevent members from seeking traditional in-office care. 
• Enhancing Member Satisfaction: User-friendly at-home testing options enhance the overall member experience. Members appreciate the convenience of managing their health without the need for travel, improving satisfaction and retention rates.
• Supporting Chronic Condition Management: At-home monitoring and health testing solutions facilitate early detection and better disease management. This proactive approach directly impacts plan performance metrics for managing chronic illnesses.
• Reducing Health Disparities: At-home health testing helps address inequities in healthcare by underserved populations. This aligns with CMS’s push for inclusive care delivery and contributes to higher ratings in health equity measures.

Ready to chat more about start ratings and closing care gaps?

You can contact us here for more information on how Ash can support your healthcare initiatives!