The CMS Star Ratings program is a critical benchmark for Medicare Advantage plans, dramatically influencing member enrollment and reimbursement rates.
The CMS Star Ratings program remains a critical benchmark for Medicare Advantage plans, heavily influencing member enrollment and reimbursement. In 2025, new challenges like higher cut points and post-pandemic utilization trends have added complexity to achieving high Star Ratings. With the introduction of the Health Equity Index (HEI) and other evolving measures, achieving high Star Ratings means staying ahead of the curve.
- 209 plans achieved 4 Stars or higher in 2025, down from 242 in 2024.
- Only 62% of members are in 4-Star plans, down from 74% in 2024.
These shifts underscore the growing difficulty of maintaining top ratings in an increasingly competitive and constrained environment.
Why Choose Icario for Star Ratings Improvement?
Icario leverages data from millions of member touchpoints, advanced behavioral insights, and our proprietary engagement platform to drive meaningful improvements in Star Ratings. Our personalized, data-driven approach ensures high engagement rates, closes care gaps, and enhances member satisfaction. As a result, health plans partnering with Icario experience a tremendous boost in performance and improved member satisfaction rates.
300%
increase in high-value healthcare activities
75%
of members said an Icario program improved their satisfaction with the plan
6x ROI
from Quality Bonus Payments (QBP)
Comprehensive Data Utilization
Icario leverages extensive member data to provide actionable insights that improve Star Ratings. By identifying key areas for improvement and tailoring interventions to specific member needs, we help enhance a health plan’s performance across every measured category.
Predictive Insights for Quality Improvement
Predictive behavioral science tools enable us to forecast member behaviors and design interventions that address potential gaps in care before they occur. This proactive approach ensures that plans will not only meet but exceed Star Ratings criteria.
Integrated Engagement Strategies
Our proprietary engagement platform integrates real-time analytics with personalized communication strategies to optimize member outreach. By focusing on whole person data, we create effective engagement plans that drive better health outcomes and improve Star Ratings.
2025 Star Ratings Summary
This year has brought several significant updates to the Medicare Advantage Star Ratings program, highlighting new challenges and areas of focus for health plans:
- Rising Cut Points: In 2025, more stringent cut points are making it increasingly difficult for plans to achieve top ratings. Even though many plans saw improvements in key performance areas, the higher benchmarks led to a decrease in overall Star Ratings.
- Health Equity Focus: CMS has replaced the Reward Factor with the Health Equity Index (HEI), underscoring the agency’s push to address disparities in care. Health plans now need to concentrate on serving underserved populations to stay competitive and meet financial targets.
- Fewer 4.0+ Star Plans: The percentage of Medicare Advantage plans earning 4.0 stars or higher has declined, dropping from 242 plans in 2024 to 209 in 2025. This decline means fewer plans will benefit from the quality bonus payments associated with higher Star Ratings.
- Post-Pandemic Healthcare Trends: Health care utilization has surged post-pandemic, surpassing pre-2020 levels. This increase in demand is straining plan resources, making cost management more difficult while maintaining high-quality care.
- Contraction in the MA Market: A growing number of health plans are choosing to exit the Medicare Advantage market due to rising costs and shrinking margins, hinting at potential industry consolidation.
Key Focus Areas for Health Plans in 2025:
- Shift Back to Clinical Performance: Health plans should refocus their attention on clinical measures such as HEDIS and HOS, ensuring that care quality and outcomes remain top priorities.
- Utilize Health Risk Assessments (HRA) Data Effectively: Maximizing the value of HRA data by identifying and addressing care gaps early can lead to better health outcomes and improved Star Ratings.
- Proactive Member Engagement: Plans need to adopt real-time, agile interventions to meet member needs, reducing lag in responding to known issues that affect care quality and ratings.
Future Considerations Excel in 2025 and Beyond
- Mandatory Member Communication: New CMS rules require plans to proactively communicate with members about their benefits and usage, which could lead to higher engagement costs but also greater member satisfaction.
- Retention and Marketing: With fewer 4.0+ star plans available, retaining members and attracting those switching from lower-rated plans will be crucial during the Annual Enrollment Period (AEP).
To stay competitive in 2025, health plans must prioritize health outcomes, optimize data usage, and leverage proactive member engagement strategies. For more insights on how the 2025 Star Ratings will impact Medicare Advantage plans, read our latest blog post.
