humana files lawsuit against cms over 2025 medicare advantage star ratings

Humana has filed a lawsuit against the Centers for Medicare and Medicaid Services (CMS) regarding the 2025 Medicare Advantage and Part D Star Ratings.

Background

The complaint alleges that CMS did not follow its decision-making protocols and did not provide necessary data for validating the ratings.

Humana argues that the star ratings are important for agents, brokers, and beneficiaries to make informed plan comparisons during the annual enrollment period.

Higher star ratings can also result in substantial quality bonus payments from CMS.

The number of beneficiaries enrolled in Medicare Advantage has surpassed those in traditional Medicare for the first time, making this legal battle significant.

Humana's lawsuit follows similar actions taken by UnitedHealth Group, and Elevance is also considering its options.

Changes in cut points have affected Humana's ratings, with a significant decline in the number of enrollees in plans rated 4.0 stars or higher.

The lawsuit also raises concerns about the transparency of the data used for the star ratings and compliance with regulatory requirements.

The overall trend in Medicare Advantage shows a decrease in the number of plans receiving top ratings.

The outcome of this lawsuit could have implications for the Medicare Advantage sector and the calculation of star ratings.

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