medicare advantage star ratings 2025 reveal winners and losers in healthcare

The strategies of insurers will be influenced by the changing dynamics of the Medicare Advantage market in the coming years.

Effects of 2025 Medicare Advantage Star Ratings

Newer entrants like Alignment Healthcare and Clover Health have benefited from the star ratings, while established players like UnitedHealth and Humana face challenges. Leading insurers have seen a decline in their average star ratings, with UnitedHealth experiencing the largest drop. Humana has seen a significant portion of its members move to lower-rated plans. CVS Health may attract former Humana members, as many have transitioned to lower-rated options. Aetna has managed to retain a higher percentage of its members in higher-rated plans compared to Humana. Blue Cross Blue Shield plans, particularly in Florida and Minnesota, have also faced challenges. Elevance Health has seen an increase in its membership in lower-rated plans. Despite these setbacks, investor sentiment remains stable for UnitedHealth and Cigna, while Humana's stock has rebounded. Centene has seen a decrease in its average star rating but an improvement in the percentage of its members in higher-rated plans. Clover Health and Alignment Healthcare have achieved impressive results in the star ratings. Clover has a high percentage of its members in a PPO offering that has improved in rating. Alignment Healthcare has maintained a strong position, with high ratings for its contracts. The shifting star ratings are expected to drive plan switching in 2025, benefiting companies that deliver higher-quality plans. Other insurers like SCAN Health Plan and Kaiser Permanente have also seen improvements in their star ratings. Healthfirst has emerged as the highest-rated HMO plan in New York City. Plans with higher star ratings receive benefits such as quality bonus payments and strategic marketing advantages. Humana and UnitedHealth are taking action in response to their scores. Previous court rulings have favored other insurers in similar disputes with the Centers for Medicare & Medicaid Services.

Plan Switching and Benefits

Plan switching in 2025 is expected due to the shifting star ratings. Companies that deliver higher-quality plans are likely to benefit from this trend. Plans with higher star ratings receive benefits such as quality bonus payments and strategic marketing advantages.

Impacts on Insurers

UnitedHealth and Humana, two established players in the Medicare Advantage market, have faced challenges with declining star ratings. UnitedHealth experienced the largest drop in its average star rating, while Humana saw a significant portion of its members move to lower-rated plans. However, investor sentiment remains stable for UnitedHealth and Cigna, and Humana's stock has rebounded. Other insurers like Alignment Healthcare, Clover Health, SCAN Health Plan, and Kaiser Permanente have achieved impressive results in the star ratings, with high ratings for their contracts and improvements in their star ratings.

Actions Taken by Humana and UnitedHealth

Humana and UnitedHealth are taking action in response to their star ratings. Previous court rulings have favored other insurers in similar disputes with the Centers for Medicare & Medicaid Services.

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