Star Ratings 101: How At-Home Testing Moves the Needle

For Medicare Advantage health plans, Star Ratings carry direct financial consequences. Plans at four stars or above qualify for CMS quality bonus payments, a program set to distribute more than $13 billion to qualifying plans in 2026, a figure that has more than quadrupled since 2015. Plans below that threshold receive nothing from the program.

The share of enrollees in qualifying plans has been narrowing. Just 68% of Medicare Advantage members are in a four-star-or-above plan in 2026, down from 75% the year before. For plans that slipped below the threshold, the practical question is what actually moves a Star Rating. For most, HEDIS is the most actionable lever and at-home testing is increasingly how plans are moving it.

What Star Ratings Are and Why They Matter

CMS rates every Medicare Advantage plan on a one-to-five-star scale each year, covering preventive screenings, chronic disease management, member experience, and administrative performance. Plans at four stars or above receive quality bonus payments that affect per-member revenue in a meaningful way. Plans below that threshold are excluded from the program.

Star Ratings also shape member acquisition. Higher-rated plans get more year round open enrollment during the Annual Enrollment Period, and both members and the brokers who advise them treat ratings as a selection factor. The financial and competitive stakes together make gap closure strategy a priority, not an afterthought.

HEDIS is the Anchor

While HEDIS and Star Ratings are governed by two different entities - HEDIS by the National Committee for Quality Assurance and Star Ratings by Centers for Medicaid and Medicare Services - they are closely intertwined. 

HEDIS measures carry some of the most significant weight among the components that drive a plan's Star Rating, and that weight is increasing. For 2026, HEDIS accounts for roughly 25% of a plan's total rating, up from 24% the year prior, with further increases scheduled through 2029.

HEDIS is, by design, a measure of what members actually do. Whether a member completed a colorectal cancer screening, received a kidney health evaluation, or stayed current on cervical cancer screening — those are behavioral outcomes, and coverage alone doesn't produce them. This is where most plans run into the same problem: eligible members have access to care but aren't completing the screenings that HEDIS tracks.

The Access Problem Outreach Alone Can't Fix

The gap between access and action is well-documented. Only about 8% of U.S. adults receive all of the high-priority preventive care recommended for them, despite most having insurance. That gap shows up directly in HEDIS performance for Medicare Advantage, Commercial, and Medicaid plans.

The hardest-to-reach members typically know care is available. The barrier is something else: clinic hours that don't work, distrust of clinical settings, physical limitations, or a general reluctance to seek care without a specific symptom pushing them. A reminder mailer doesn't resolve any of those things. It's the same channel delivering the same ask to someone who already didn't respond.

Cervical cancer screening illustrates the problem well. Despite being one of the most preventable cancers when caught early, half of all new cervical cancer cases occur in women who have never been screened or haven't been screened in more than five years. These are members who have consistently declined clinical engagement. Another reminder is unlikely to change that.

HPV self-collection is gaining significant attention among health plan leaders because it sidesteps the clinical barrier entirely. An at-home HPV test arrives at the member's door. There's no appointment to schedule, no clinic to travel to. The completion barrier drops substantially, and the care gap follows.

How At-Home Testing Can Help

At-home testing programs are built on a straightforward premise: if the barrier is access, remove it. Kits ship directly to members under the plan's brand. Members complete the test at home and return it by prepaid mail, and results route back through clinical review without requiring a clinic visit.

When health plans pair at-home kit delivery with an omni-channel activation approach — email, SMS, AI powered outreach  — members complete testing at 2.4 times the rate of single-channel programs. The improvement is better explained by friction reduction than by awareness. Members who weren't completing screenings before weren't uninformed; the path to completion was just harder than the path to doing nothing.

The Measures Where At-Home Testing Has the Greatest Impact

Several of the most commonly lagging HEDIS measures are well-suited to at-home testing, and they tend to be the ones health plan leaders flag most often when discussing Stars performance.

Colorectal Cancer Screening (COL). The FIT test is well-established as an effective, non-invasive alternative to colonoscopy and well-suited to at-home delivery. Plans that have moved from clinic-dependent colonoscopy outreach to mailed FIT programs have seen meaningful movement in COL completion rates, particularly among members who weren't responding to prior outreach.

Cervical Cancer Screening (CCS). At-home HPV testing addresses a specific barrier: women who avoid pelvic exams. The CCS measure tracks cervical cancer screening for women aged 24 to 64, and for those who won't engage in a clinical setting, HPV self-collection offers a direct path to completion that clinical outreach doesn't.

Kidney Health Evaluation for Patients with Diabetes (KED). Diabetic members who aren't regularly seeing their providers are difficult to close on this measure through conventional means. An at-home blood and urine collection kit, completed on the member's schedule, removes the appointment dependency.

HbA1c Screening for Patients with Diabetes (GSD). Glycated hemoglobin testing is another measure that maps well to at-home blood spot collection. Members with diabetes who haven't had a recent A1c test are a defined, targetable cohort — and a dried blood spot card sent to the right lab produces a clinically valid result.

Chlamydia Screening in Women (CHL). This measure depends on a member actively seeking out testing, which is exactly the behavior clinical outreach struggles to prompt. An at-home collection kit removes the step members are least likely to take on their own — scheduling a visit for a screening they may feel hesitant to discuss in person.

What these measures share is that the completion gap is driven less by the complexity of the test and more by the friction of getting members into a clinical setting to take it. Removing that requirement changes the outcome.

The Star Ratings Timeline: Why This Year's Care Shows Up Two Years Later

Gap closure planning gets harder to reason about once you factor in the lag between when care happens and when it actually shows up in a rating. Three distinct years are in play, and they're easy to conflate.

Measurement Year (MY) is the calendar year the care itself happens: a completed CCS kit, a returned COL test, a KED result. This is the performance year HEDIS tracks.

Reporting Year comes next. In MY+1, plans submit HEDIS, CAHPS, and HOS data to NCQA and CMS, typically by June.

Star Rating Year is when that data becomes public. CMS publishes the rating in October of MY+1, built from the reporting year's submission. That published rating then governs the plan's MY+2 contract year: premiums, bonuses, and marketing all follow from it.

Here's how that plays out for a kit completed right now. Care delivered in 2026 counts toward MY 2026. That data reaches NCQA in June 2027. CMS publishes the 2028 Star Ratings in October 2027, built entirely on MY 2026 performance, and those ratings determine the plan's premiums and bonus eligibility for the 2028 contract year.

The distance between a completed kit and its effect on a rating runs close to two years. Treating gap closure as a fourth-quarter push means working against a clock that started well before anyone noticed it.

Closing the Gap Before Year-End

The HEDIS measurement year runs January through December, and whatever a plan closes this year won't surface publicly until the Star Ratings two years out. Programs that launch in July, August, or even September still have time to generate MY 2026 data before the measurement window closes on December 31 — data that will directly shape the 2028 Star Ratings CMS publishes in October 2027. Programs that wait until Q4 to engage a partner often run out of runway, and miss folding that year's activity into the cycle at all.

Ash has processed over 4 million biomarkers across the country,² supporting hundreds of healthcare organizations⁴ on measures including COL, CCS, KED, GSD, CHL, and others. Programs are fully white-labeled under your plan's brand, with multi-channel member outreach and dedicated clinical oversight included.

If your plan is evaluating where at-home testing fits in your H2 strategy, we'd like to talk.

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