New Star Ratings Shed Light on the Best — and Worst — Performing Health Plans for Seniors
Choosing the right Medicare coverage is one of the most consequential healthcare decisions millions of older Americans make each year. To help guide that choice, the Centers for Medicare & Medicaid Services (CMS) publishes annual quality assessments for every Medicare Advantage and Part D prescription drug plan operating in the country. The freshly released 2026 scores offer a detailed snapshot of how the nation’s largest private insurers are performing — and where some are falling short.
The evaluation framework weighs a broad range of performance indicators, from enrollee satisfaction and timely access to physicians to how effectively plans help patients manage long-term health conditions like diabetes, heart disease, and hypertension. Prominent carriers including UnitedHealthcare, Aetna, Humana, Elevance Health, and Centene all received updated scores that will shape enrollment decisions — and corporate bottom lines — in the coming year.
For the more than 30 million Americans currently enrolled in Medicare Advantage, understanding what these scores mean and how they are calculated has never been more important.
Decoding the Star Rating System
How CMS Measures Plan Quality
Each year, CMS conducts a comprehensive evaluation of every Medicare Advantage contract in the country, scoring each on a scale from one star (poorest performance) to five stars (highest quality). The assessment draws on dozens of individual metrics organized into several broad categories:
Member Experience and Satisfaction: How do enrollees rate their overall plan experience? Are they satisfied with their access to specialists, the responsiveness of customer service, and the ease of obtaining needed prescriptions?
Clinical Quality and Outcomes: Does the plan effectively coordinate care for members with chronic illnesses? Are preventive screenings — mammograms, colonoscopies, annual wellness visits — being delivered at appropriate rates? Are patients with conditions like diabetes maintaining healthy blood sugar levels?
Access and Responsiveness: Can members get timely appointments with primary care physicians and specialists? Are complaints and appeals resolved quickly and fairly?
Pharmacy Performance (for plans that include drug coverage): Are prescriptions filled accurately and efficiently? Does the plan encourage the use of cost-effective generic medications where appropriate?
These individual measures are aggregated into an overall star rating for each plan contract. Plans earning four or more stars qualify for the designation of “high-quality” or “premium-rated” — a distinction that carries both reputational and financial significance.
Why Stars Equal Dollars
The rating system is far more than an informational tool for consumers. It functions as a powerful financial lever within the Medicare Advantage ecosystem.
Under federal rules, plans achieving four stars or above qualify for quality bonus payments from CMS — supplementary funding that can amount to hundreds of millions of dollars annually for the largest carriers. These bonus payments can be used to enhance benefits, reduce member premiums, or improve profit margins. Over a multi-year period, the cumulative financial difference between a 3.5-star rating and a 4.5-star rating can reach into the billions for a major national insurer.
This structure creates a potent incentive for carriers to invest in quality improvement initiatives, care coordination programs, and member engagement strategies. It also means that a downgrade of even half a star can trigger significant revenue losses and competitive disadvantage.
2026 Performance: Carrier-by-Carrier Breakdown
UnitedHealthcare: Scale Meets Consistency
UnitedHealthcare, a subsidiary of UnitedHealth Group, remains the dominant force in the Medicare Advantage landscape by sheer enrollment volume. With approximately 10.3 million Medicare Advantage members spread across hundreds of plan contracts nationwide, it is the single largest private Medicare carrier in the country.
For 2026, more than 77 percent of UnitedHealthcare’s Medicare Advantage enrollees are covered under plans that achieved four-star ratings or better. Given the enormous scale of United’s operations — spanning urban, suburban, and rural markets in nearly every state — maintaining this level of quality consistency represents a significant operational achievement.
The company’s breadth of offerings ranges from health maintenance organization (HMO) plans with tightly managed provider networks to preferred provider organization (PPO) plans that offer greater flexibility in choosing doctors and hospitals. Its chronic disease management programs, particularly for diabetes and cardiovascular conditions, have been cited as contributing factors to its sustained high ratings.
However, UnitedHealthcare has not been immune to broader industry pressures. As noted in recent coverage of Medicare Advantage market exits, the company withdrew from counties covering roughly 600,000 beneficiaries ahead of the 2026 plan year — a reminder that even the highest-rated carriers are making difficult market calculations.
Aetna: The CVS Health Advantage
Aetna, which has operated as a division of CVS Health since the companies merged in 2018, posted some of the strongest quality numbers among major Medicare Advantage carriers for 2026. Approximately 81 percent of its 4.2 million Medicare Advantage members are enrolled in plans carrying premium four-star-plus ratings.
The CVS integration appears to be paying dividends in the Medicare space. Aetna can leverage CVS’s vast retail pharmacy network, MinuteClinic locations, and health data infrastructure to support care coordination and medication adherence — both key drivers of star rating performance. The company’s ability to connect pharmacy data with medical claims gives it visibility into whether members are filling prescriptions, managing chronic conditions, and utilizing preventive services.
Aetna’s 81 percent premium-rated enrollment figure places it at or near the top among large national carriers on this metric, reflecting both strong clinical program execution and effective member engagement.
Humana: A Difficult Reckoning
Humana, traditionally one of the three pillars of the Medicare Advantage market alongside UnitedHealthcare and Aetna, enters 2026 facing its most challenging quality landscape in recent memory.
Only about 20 percent of Humana’s 5.8 million Medicare Advantage members are enrolled in plans that earned four stars or higher — a figure that lags dramatically behind its primary competitors. The implications are substantial on multiple fronts:
Financial Impact: With roughly 80 percent of its membership in plans rated below the premium threshold, Humana stands to forfeit significant quality bonus payments from CMS. For a company of Humana’s scale, this revenue gap could amount to hundreds of millions of dollars annually — money that competitors will be using to enrich benefits and attract new enrollees.
Competitive Positioning: In a marketplace where beneficiaries (and the brokers who advise them) increasingly rely on star ratings as a shorthand for plan quality, Humana’s relatively low scores could accelerate membership losses to higher-rated rivals. During each fall’s Annual Enrollment Period, plans with conspicuously lower ratings face heightened scrutiny.
Strategic Questions: The rating shortfall raises broader questions about Humana’s care management infrastructure, provider network adequacy, and member satisfaction initiatives. Whether the company can engineer a meaningful rating recovery in upcoming cycles — star ratings typically reflect performance data from one to three years prior — will be closely watched by industry analysts and investors.
Humana has publicly acknowledged the ratings challenge and indicated it is investing in quality improvement programs, though specific details and timelines remain limited.
Elevance Health: Solid but Not Spectacular
Elevance Health — the corporate entity formerly known as Anthem, which operates Blue Cross Blue Shield plans in 14 states — occupies a middle position in the 2026 ratings landscape. Roughly 55 percent of its Medicare Advantage membership is enrolled in plans that achieved four-star or higher designations.
While this figure trails the leaders, it represents a respectable showing for a company whose Medicare Advantage footprint spans diverse geographic and demographic markets. Elevance’s performance varies considerably by region, with some of its state-level Blue Cross Blue Shield plans earning top marks while others pull the national average downward.
The company has been expanding its Medicare Advantage presence in recent years, particularly in markets where it can leverage existing commercial insurance provider relationships. Its challenge for coming years will be raising quality scores across its full portfolio rather than just in select high-performing markets.
Centene: An Upward Trajectory
Centene Corporation, which built its reputation primarily as a Medicaid managed care company before expanding aggressively into Medicare Advantage, demonstrated measurable quality improvements in the 2026 ratings cycle. While the company has not disclosed the specific percentage of members in premium-rated plans, the upward movement in its scores signals that investments in care coordination, member outreach, and clinical program development are beginning to yield results.
Centene’s Medicare Advantage membership skews toward dual-eligible individuals — those who qualify for both Medicare and Medicaid simultaneously. This population tends to have more complex health needs, lower health literacy, and greater social determinants of health challenges, all of which can make achieving high star ratings more difficult. The company’s improving scores in the context of this more challenging patient population is noteworthy.
Nevertheless, Centene still has considerable ground to cover before it matches the quality benchmarks set by UnitedHealthcare and Aetna. Building sustained rating improvements with a medically complex membership base requires long-term investment in care management infrastructure that takes years to mature.
Beyond the Headlines: What Ratings Mean for Everyday Beneficiaries
Practical Implications at Enrollment Time
For the average Medicare-eligible American evaluating coverage options during the Annual Enrollment Period each fall, star ratings serve as one of the most accessible and standardized comparison tools available. But translating a numerical score into a real-world coverage decision requires understanding what the ratings do — and do not — capture.
What high ratings generally indicate:
- Members report positive experiences with their plan and its customer service
- The plan demonstrates effective programs for managing chronic health conditions
- Preventive services are delivered at rates meeting or exceeding national benchmarks
- Prescription drug coverage is administered efficiently and accurately
- Complaints, grievances, and appeals are handled in a timely manner
What ratings may not fully reflect:
- Whether specific doctors or hospitals you prefer are included in the plan’s network
- The actual out-of-pocket costs you would face for your particular health conditions and medications
- How the plan performs in your specific county or region (ratings are assigned at the contract level, which may span multiple states)
- Recent changes to benefits, formularies, or provider networks that haven’t yet been captured in the rating data
The Time Lag Factor
One important caveat for beneficiaries: star ratings are inherently backward-looking. The 2026 scores are based on clinical quality data, member satisfaction surveys, and operational metrics from prior years — in some cases, data collected as far back as 2023 or 2024. A plan that has recently made significant improvements (or experienced notable declines) may not see those changes reflected in its current rating.
This means that a plan with a strong historical rating could be in the process of cutting benefits, narrowing its provider network, or even preparing to exit certain markets — developments that wouldn’t yet appear in its star score. Conversely, a plan that received mediocre ratings based on older data may have since implemented substantial quality enhancements.
Using Ratings as One Tool Among Several
Healthcare policy experts generally recommend that beneficiaries treat star ratings as a valuable starting point rather than the sole basis for plan selection. A comprehensive evaluation should also consider:
- Network adequacy: Are your current physicians, specialists, and preferred hospitals included in the plan’s provider network?
- Prescription formulary: Does the plan cover your specific medications, and at what tier (which determines your copayment)?
- Total cost of coverage: Beyond monthly premiums, what are the plan’s deductibles, copayments, coinsurance rates, and annual out-of-pocket maximum?
- Supplemental benefits: Does the plan offer dental, vision, hearing, fitness, or transportation benefits that are important to you?
- Plan stability: Has the carrier demonstrated a commitment to your geographic market, or has it been exiting counties and reducing coverage in recent years?
The Bigger Picture: Quality Ratings in a Shifting Market
Financial Pressures Reshaping the Landscape
The 2026 ratings arrive at a turbulent moment for the Medicare Advantage industry. As documented in recent reporting, nearly 3 million beneficiaries were involuntarily displaced from their plans when carriers withdrew from unprofitable markets. Rising healthcare utilization among aging Baby Boomers, combined with CMS efforts to rein in overpayments to private plans, has squeezed profit margins across the sector.
In this environment, star ratings take on heightened importance. Carriers that maintain high scores secure bonus payments that can partially offset margin compression elsewhere. Those with declining ratings face a compounding problem: reduced bonus revenue arrives precisely when they can least afford it, potentially triggering further benefit reductions or market exits.
The Quality Bonus Feedback Loop
This dynamic creates what health economists describe as a quality bonus feedback loop:
- High-rated plans receive bonus payments → enabling richer benefits and lower premiums
- Attractive benefits draw healthier, more engaged members → further improving quality metrics
- Improved metrics sustain or elevate star ratings → generating continued bonus payments
Conversely, plans that fall below the four-star threshold can enter a negative spiral:
- Lower ratings mean no bonus payments → forcing benefit reductions or premium increases
- Diminished benefits drive away healthier members → leaving a sicker, more costly risk pool
- Higher costs and lower satisfaction depress future ratings → perpetuating the cycle
This feedback mechanism helps explain the widening gap between top-performing carriers like UnitedHealthcare and Aetna and struggling competitors like Humana. Breaking out of a negative ratings cycle requires substantial upfront investment in quality infrastructure — spending money now to improve scores that won’t be reflected in ratings for two to three years.
Regulatory Evolution
CMS has periodically adjusted its star rating methodology, adding new measures, modifying weighting formulas, and raising performance thresholds. These changes can significantly affect carrier scores independent of any actual change in care quality. The agency has signaled that future rating cycles may place greater emphasis on health equity measures — evaluating how well plans serve members across different racial, ethnic, and socioeconomic groups.
For carriers, this means the quality improvement target is continuously moving. Strategies that produced four-star ratings in previous years may prove insufficient under evolving CMS standards, requiring ongoing adaptation and investment.
What Beneficiaries Should Do Now
Key Action Steps
For Medicare-eligible Americans evaluating their options for the upcoming plan year:
1. Check Current Plan Ratings: Visit Medicare.gov/plan-compare to look up the star rating for your current plan and compare it with alternatives available in your area.
2. Review Plan Changes Annually: Even if your plan maintains a strong rating, benefits, provider networks, and drug formularies can change from year to year. Read the Annual Notice of Change (ANOC) document your plan sends each September.
3. Assess Plan Stability: Research whether your carrier has been exiting markets or reducing coverage in neighboring areas — potential warning signs of future instability in your county.
4. Seek Free Counseling: Contact your state’s State Health Insurance Assistance Program (SHIP) for unbiased, no-cost guidance. Trained counselors can help you compare options based on your specific health needs, medications, and financial situation. Reach SHIP at 1-877-839-2675 or visit shiphelp.org.
5. Mark Key Dates: The Medicare Annual Enrollment Period runs from October 15 through December 7 each year. The Medicare Advantage Open Enrollment Period extends from January 1 through March 31, allowing current Advantage enrollees to switch plans or return to Original Medicare.
Looking Ahead
The 2026 star ratings underscore a Medicare Advantage market in transition. The era of uniformly expanding benefits and aggressive market entry appears to be giving way to a more selective, financially disciplined approach by carriers. For beneficiaries, this shifting landscape makes informed, proactive plan evaluation more critical than ever.
The carriers that earn and sustain high quality ratings will likely emerge as the long-term winners in this evolving market — attracting members, securing bonus payments, and building the kind of care management infrastructure that delivers genuine health value. Those that cannot meet rising quality standards may find themselves caught in a downward cycle of shrinking enrollment, reduced revenue, and eventual market retreat.
For the millions of seniors whose health and financial security depend on these private Medicare plans, the star ratings offer an imperfect but invaluable window into which companies are delivering on their promises — and which are not.
