2025 Star Ratings Deliver ‘Reckoning’ That Will Drive Quality, Leading Expert Says

Oct 17
Oct 17, 2024

CMS on Oct. 10 revealed that 40% of Medicare Advantage Prescription Drug (MA-PD) plans — or 209 contracts — that will be offered in 2025 earned an overall Star Rating of 4 or higher, thus qualifying for quality bonus payments (QBPs) in 2026. That percentage compares with 45% of MA-PDs after CMS’s unprecedented recalculation of the 2024 Star Ratings and follows a continued decline in overall ratings since the expiration of pandemic-era flexibilities. The 2025 Star Ratings also resulted in just seven MA-PD contracts earning 5 stars, compared with 38 in 2024, while the average overall MA-PD rating fell from 4.07 to 3.92.

Prior to CMS’s release of the 2025 Star Ratings, industry analysts had signaled that nearly two-thirds of measure-level cut points increased from the 2024 Star Ratings, meaning contracts in general had to achieve higher performance on these measures to perform well. This was also the second year that CMS applied the new Tukey outlier deletion methodology to the clustering methodology used to establish cut points for the non-Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures. And it was the second year in which CMS used new cut point “guardrails” to limit the upward and downward movement of cut points by 5% in either direction, which was the primary source of controversy in the 2024 Star Ratings.
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Lauren Flynn Kelly

Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.