What do the 2026 Medicare Advantage Star Ratings Mean for Health Plans?

The Centers for Medicare & Medicaid Services (CMS) has released the 2026 Medicare Advantage (MA) Star Ratings, revealing a landscape that rewards meticulous quality strategy more than ever before. For health plans, Medicare Advantage Star Ratings are not simply a scorecard; they’re a competitive advantage. Ratings directly govern revenue, including access to lucrative Quality Bonus Payments (QBP), and drive enrollment during the Annual Election Period (AEP).

The data confirms that MA plans have stabilized the average rating after previous years of decline, nudging the overall market score slightly upward. However, beneath the surface, the requirements for achieving top-tier performance have grown increasingly stringent (CMS). Additionally, while ratings are stabilizing, some key preventive measures (like FIT) and many HD2: Managing Chronic (Long Term) Conditions measures are still falling below the 4 star threshold and could be an opportunity for growth for health plans.  

The New Map: Key Changes Driving 2026 Performance

Our analysis of the final ratings methodology (CMS) highlights several critical shifts that health plans must address to remain competitive. These technical changes intensify the focus on measurable clinical outcomes:

• Emphasis on High-Weight Clinical Measures: Clinical outcomes and intermediate outcomes—such as Diabetes Care – Blood Sugar Controlled and Controlling Blood Pressure —continue to carry a weight of 3, making them crucial levers for improving overall ratings.
• Introduction of New Measures: New measures entering the calculation, including the Kidney Health Evaluation for Patients with Diabetes, carry an initial weight of 1, providing new targets for proactive quality intervention in a key domain of chronic care.
• Weighting Shift from Member Experience: CMS significantly reduced the weight of Patient Experience, Complaints, and Access measures from a factor of 4 down to 2. This rebalancing diminishes the impact of measures like Customer Service and appeals on the final score, and deliberately places greater emphasis on clinical and pharmacy outcomes.

This concerted shift means plans can no longer rely heavily on favorable administrative or experience scores; successfully driving clinical results is now paramount to achieving a 4-star-plus rating.

The Data’s Determined Takeaway

While the average weighted Star Rating stabilized, individual plan results were highly bifurcated, underscoring the increasing difficulty of securing the coveted 4-star-and-above threshold:

• A Mixed Bag for Market Leaders: Several major players saw the percentage of their membership in 4-star plans drop, indicating margin pressure and a need for immediate strategic realignment. Conversely, other plans saw meaningful improvements, demonstrating that investment in a robust quality strategy pays clear dividends.
• The Smallest Pool for Top Performers: Only 18 contracts achieved 5 stars in the 2026 ratings, up from only 7 in the previous year - but still below 2024’s total of 38 plans. This exclusive group highlights the stringent quality required to earn the highest marks, creating immense separation between top performers and the rest of the market (CMS).
• Stakes are Higher than Ever: Plans that suffer rating declines may be forced to either cut supplemental benefits or increase premiums to protect margins, severely impacting their competitive positioning during AEP.
• Continued Improvement is Necessary: with 36% of members in plans under a 4 star rating, the plans that are reaching that status are more desirable than ever (CMS).

Our Strategy: Reliable Paths to Improve Star Ratings

Ash offers determined, knowledgeable solutions designed to meet the CMS heightened focus on measurable clinical outcomes and health equity. By leveraging our at-home testing platform, your organization can efficiently address the most challenging and highest-weighted gaps in care.

Target Critical Clinical Gaps

We simplify the collection and submission process for key clinical measures, reducing member friction and dramatically increasing completion rates.

• Master the KED Measure: The addition of the Kidney Health Evaluation for Patients with Diabetes measure signals a focus on proactive Chronic Kidney Disease (CKD) screening. Ash provides at-home testing solutions for the key biomarkers needed for this measure - Creatinine (Serum), eGFR, and uACR. This easily integrates screening into a member’s regular routine, removing the logistical barriers that often result in missed or delayed testing.
• Elevate Diabetes and Blood Pressure Control: These 3-weight intermediate outcome measures benefit directly from simplified adherence and monitoring. We offer kits for HbA1c testing and leverage partnerships for Remote Patient Monitoring (RPM) devices like blood pressure cuffs to ensure members regularly track vitals and manage chronic conditions proactively.
• Boost Preventive Screening: Essential screenings like Colorectal Cancer Screening remain fundamental. Our white-labeled FIT screening programs increase kit return rates, helping you meet annual requirements and demonstrably closing care gaps.

Achieve Health Equity & Engagement Goals

CMS is committed to Meaningful Measures that promote person-centered care and reduce health disparities {{citation opportunity}}. Our technology is purpose-built to deliver on this promise.

• Remove Access Barriers: At-home health programs directly address barriers like travel, lack of childcare, and stigma, ensuring that underserved populations—a core focus of Health Equity initiatives—can complete essential health steps.
• Seamless, Branded Experience: Our approach minimizes friction by providing a unified, customized, and reliable experience from white-labeled kit design to digital result delivery. This attention to detail fosters member trust and encourages compliance.

If you’re ready to close high-impact care gaps and confidently navigate the new Star Ratings environment - connect with Ash, we’d love to chat.

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