The Centers for Medicare & Medicaid Services (CMS) prioritizes ensuring Medicare’s effectiveness for seniors and individuals with disabilities. A key aspect of this commitment is providing Medicare beneficiaries with access to reliable, stable, high-quality, and affordable coverage options. Central to this mission is the continuous enhancement of Medicare Advantage (MA) and Part D programs. The recently released 2025 Star Ratings exemplify CMS’s ongoing efforts to drive quality improvement within these programs, aiming to guarantee that Medicare enrollees receive superior care and that plans are motivated to pursue ever-higher standards of quality.
Each year, CMS publishes the Medicare Advantage (Medicare Part C) and Medicare Part D Star Ratings to evaluate the quality of healthcare and prescription drug services experienced by individuals enrolled in MA and Part D prescription drug plans (PDPs). This Star Ratings system is designed to be a user-friendly tool, empowering people with Medicare to effectively compare the quality of different Medicare health and drug plans. By offering clear quality metrics alongside information about benefits and costs, Medicare beneficiaries and their caregivers are better equipped to compare plans and select the Medicare coverage that best aligns with their unique healthcare needs.
The 2025 Star Ratings are now available on the Medicare Plan Finder for the 2025 open enrollment period. These ratings are not just for consumer information; they also play a crucial role in determining 2026 MA quality bonus payments, further incentivizing plans to maintain and improve their service quality.
Key Highlights of 2025 Medicare Star Ratings
Medicare evaluates plan performance rigorously. Medicare Advantage Prescription Drug (MA-PD) contracts are assessed on up to 40 distinct quality and performance measures. MA-only contracts, which do not include Part D coverage, are rated on up to 30 measures, while PDP contracts are evaluated on up to 12 measures. For each of these measures, CMS establishes specific performance benchmarks, known as “cut points.” These cut points determine whether a contract’s performance for a given measure earns a 1-, 2-, 3-, 4-, or 5-star rating.
Minimal Changes in Methodology for 2025, Focus Remains on Quality
For the 2025 Star Ratings, CMS maintained a consistent methodological approach, ensuring stability and predictability in how plans are evaluated. A minor adjustment was implemented, increasing the weight of the Part C Plan All-Cause Readmissions measure from one to three. This change underscores the importance of reducing hospital readmissions and improving care transitions for Medicare beneficiaries.
Another methodological update concerns the Part D Medicare Plan Finder measure. Having moved beyond its initial phase as a new measure, it is now subject to bi-directional guardrails, starting in 2025. These guardrails are applied after mean resampling if cut points shift by more than 5%, ensuring stability and preventing drastic year-over-year fluctuations. However, for the 2025 Star Ratings, these guardrails were not activated as the cut points did not exceed the 5% threshold.
It’s important to remember that previous methodological changes introduced for the 2024 Star Ratings continue to influence the 2025 ratings. Notably, the implementation of Tukey outlier deletion in the hierarchical clustering methodology for non-Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures, introduced in the 2021 policy updates, remains in effect. This statistical technique enhances the accuracy and stability of measure-level cut points by removing extreme outliers, primarily at the lower end of performance spectrum. By minimizing the impact of these outliers, the cut points become more representative of typical performance levels. While Tukey outlier deletion can lead to upward shifts in cut points, guardrails may sometimes moderate the full effect of this adjustment in year-over-year comparisons.
Understanding the 2025 Star Rating Distribution
The distribution of Star Ratings provides valuable insights into the overall quality landscape of Medicare plans.
Alt Text: Table comparing the distribution of overall Star Ratings for Medicare Advantage Prescription Drug (MA-PD) contracts from 2022 to 2025. The table shows the number of contracts, percentage of total contracts, and percentage weighted by enrollment for each star rating level (5 stars to 2 stars) across the four years, highlighting a decrease in 5-star ratings and shifts in other categories.
Key trends from Table 1 highlight shifts in MA-PD contract performance:
- Slight Decrease in Top Ratings: Approximately 40% of MA-PD contracts (209 contracts) for 2025 achieved a rating of four stars or higher. This represents a slight decrease compared to previous years.
- Majority Enrolled in Highly Rated Plans: Despite the dip in top ratings, a significant 62% of MA-PD enrollees are in plans that will receive four or more stars in 2025, demonstrating that the majority of beneficiaries are still enrolled in high-quality plans.
It is crucial to recognize that year-over-year changes in Star Ratings are a natural part of the evaluation process. These ratings are designed to reflect a contract’s performance within a specific measurement period. Performance can fluctuate, and contracts may perform differently from year to year. Cut points are recalculated annually based on current performance data, meaning the benchmarks for achieving high ratings can change. In the 2025 Star Ratings, many measure-level cut points increased, indicating that plans had to achieve higher performance levels to maintain or improve their star ratings. This increase is a result of both improvements in contract performance and CMS’s ongoing commitment to raising the bar for quality within the program.
Several factors contributed to the changes in measure-level cut points for 2025:
- Tukey Outlier Deletion Impact: The removal of extreme outliers, particularly on the lower end of the performance spectrum, led to upward shifts in cut points for affected measures, providing a more accurate assessment of typical performance.
- Return to Pre-Pandemic Performance Levels: As healthcare operations stabilize post-pandemic, performance on some measures is reverting to pre-pandemic levels, which in some cases has contributed to increased cut points.
- Compressed Score Distribution: A more concentrated distribution of scores across contracts generally resulted in higher cut points, as performance benchmarks adjust to reflect the tighter clustering of scores.
- High Performance Benchmarking: The increasing number of contracts achieving very high scores on certain measures, such as Breast Cancer Screening (Part C), pushed the cut points for these measures upward, rewarding and incentivizing top-tier performance.
- Improved Lower-End Performance: Even improvements in scores among lower-performing contracts for some measures, like Colorectal Cancer Screening (Part C), can contribute to higher cut points, as the overall performance distribution shifts upwards.
Alt Text: Table showing the distribution of Part D Star Ratings for stand-alone Prescription Drug Plans (PDPs) from 2022 to 2025. The table details the number of contracts, percentage, and enrollment-weighted percentage for each rating level (5 stars to 2 stars) across the four years, illustrating a decrease in higher ratings and shifts in lower categories.
Table 2 provides a similar overview for stand-alone PDPs:
- Lower Percentage of Top-Rated PDPs: Approximately 27% of PDPs (11 contracts) active in 2025 received four or more stars for their 2025 Part D rating, a lower proportion compared to MA-PD plans.
- Smaller Enrollment in Top PDPs: Enrollment-weighted data shows that only about 5% of PDP enrollees are in contracts that will have four or more stars in 2025, indicating a greater concentration of enrollment in lower-rated stand-alone drug plans.
5-Star Contract Recognition and Low Performer Identification
For 2025, a select group of contracts have been recognized for exceptional performance, while others have been identified as needing improvement.
5-Star Excellence: A total of 11 contracts are distinguished with a high-performing icon on the Medicare Plan Finder, signifying a 5-star rating. These include seven MA-PD contracts, two section 1876 Cost Contracts, and two PDPs. Impressively, 10 of these high-performing contracts also achieved this recognition in 2024, demonstrating consistent excellence. Notably, six of the seven 5-star MA-PD contracts offer plan benefit packages that include Dual Eligible Special Needs Plans (D-SNP), highlighting high quality care for vulnerable populations.
Consistently Low Performers: Conversely, eight contracts have been flagged with a low-performing icon on the Medicare Plan Finder for 2025, indicating consistently low quality ratings. This is a slight increase from six contracts identified last year. This group includes seven MA-PD contracts and one PDP. Two of the MA-PD contracts with this designation include D-SNP plan benefit packages, signaling an area needing focused improvement to ensure adequate care for dual-eligible beneficiaries.
Impact of Tax Status and Program Longevity on Star Ratings
Analysis of the 2025 Star Ratings reveals interesting correlations with organizational structure and experience.
Tax Status Matters: Non-profit organizations consistently outperform for-profit organizations in Star Ratings. For MA-PDs, roughly 50% of non-profit contracts achieved four or more stars, compared to only 36% of for-profit MA-PDs. A similar trend is evident in PDPs, where approximately 41% of non-profit PDPs earned four or more stars, versus just 17% of for-profit PDPs.
Alt Text: Table comparing the distribution of 2025 Overall Star Ratings for for-profit and non-profit Medicare Advantage Prescription Drug (MA-PD) contracts. The table breaks down the number of contracts, percentage of contracts, and enrollment-weighted percentage for each star rating level (5 stars to 2 stars), separately for for-profit and non-profit entities, highlighting the higher performance of non-profit contracts.
Table 3 details the distribution of overall Star Ratings for MA-PDs by tax status.
Alt Text: Table showing the distribution of 2025 Part D Ratings for for-profit and non-profit stand-alone Prescription Drug Plans (PDPs). The table presents the number of contracts, percentage of contracts, and enrollment-weighted percentage for each star rating level (5 stars to 2 stars), separately for for-profit and non-profit organizations, emphasizing the stronger ratings achieved by non-profit PDPs.
Table 4 presents the Part D rating distribution for PDPs, also segmented by tax status.
Experience in Medicare Matters: Longer tenure in the Medicare program is generally associated with higher Star Ratings. MA-PD contracts with 10 or more years of program experience are more likely to achieve four or more stars compared to newer contracts (under five years). While the trend is less pronounced for PDPs due to fewer very new plans, the data suggests experience contributes positively to performance.
Alt Text: Table displaying the distribution of 2025 Overall Star Ratings for Medicare Advantage Prescription Drug (MA-PD) contracts, categorized by the length of time in the program (fewer than five years, five to fewer than 10 years, and 10 or more years). The table shows the number and percentage of contracts in each category for each star rating level (5 stars to 2 stars), illustrating a positive correlation between program tenure and higher star ratings.
Table 5 illustrates the relationship between program length and overall Star Ratings for MA-PDs.
Alt Text: Table showing the distribution of 2025 Part D Ratings for stand-alone Prescription Drug Plans (PDPs), grouped by length of time in the program (fewer than five years, five to fewer than 10 years, and 10 or more years). The table provides the number and percentage of contracts in each category for each star rating level (5 stars to 2 stars), suggesting a less pronounced but still potentially positive association between program experience and PDP ratings.
Table 6 presents similar data for PDPs, examining program length and Part D ratings.
Average Star Ratings Per Measure: A Deeper Dive
Examining average Star Ratings for individual measures provides a more granular understanding of performance trends across different aspects of care and service.
Alt Text: Table comparing the average Star Rating for each Part C measure from 2022 to 2025. Measures include screenings (Breast Cancer, Colorectal Cancer), vaccinations (Flu), chronic condition management (Diabetes, Hypertension), care coordination, customer service, and plan administration. The table shows average star ratings for each measure across the four years, indicating trends in performance over time.
Table 7 details the average Star Ratings for Part C measures from 2022 to 2025.
Alt Text: Table comparing the average Star Rating for each Part D measure specifically for Medicare Advantage Prescription Drug (MA-PD) plans from 2022 to 2025. Measures include call center accessibility, complaint handling, member retention, drug plan quality improvement, rating of drug plan, access to needed prescriptions, price accuracy, medication adherence, and medication therapy management. The table displays average star ratings for each measure across the four years, showing performance trends within MA-PD plans.
Table 8 presents the average Star Ratings for Part D measures within MA-PD plans.
Alt Text: Table comparing the average Star Rating for each Part D measure for stand-alone Prescription Drug Plans (PDPs) from 2022 to 2025. Measures are similar to Table 8 and include call center, complaints, member retention, quality improvement, drug plan rating, prescription access, price accuracy, medication adherence, and MTM program completion. The table shows average star ratings for each measure across the four years, revealing performance trends in stand-alone PDPs.
Table 9 shows the average Star Ratings for Part D measures in stand-alone PDPs.
Utilize Medicare Plan Finder for 2025 Open Enrollment
Understanding the 2025 Medicare Star Ratings is the first step in making informed healthcare decisions during the upcoming open enrollment. To explore specific plan options and compare them based on Star Ratings, benefits, and costs, Medicare beneficiaries are encouraged to use the Medicare Plan Finder, accessible through medicare.gov/plan-compare. This tool provides a comprehensive platform to research and compare Medicare Advantage and Part D plans available in your area, empowering you to select the coverage that best meets your individual health needs and preferences for 2025.
Conclusion
The 2025 Medicare Star Ratings offer a crucial benchmark for evaluating the quality of Medicare Advantage and Part D plans. While there have been minor methodological adjustments and shifts in rating distributions, the overarching goal remains to drive continuous quality improvement and provide beneficiaries with meaningful information for plan selection. By leveraging resources like the Medicare Plan Finder and understanding the nuances of the Star Ratings, individuals can confidently navigate the Medicare open enrollment period and choose plans that align with their healthcare priorities.
APPENDIX
Table A1: MA-PD Contracts Receiving the 2025 High-Performing Icon
| Contract ID | Contract Name | Parent Organization | 10/2024 Enrollment | 5 Star Last Year | Includes SNP Plan Benefit Packages |
|---|---|---|---|---|---|
| H3957 | HIGHMARK CHOICE COMPANY | Highmark Health | 55,015 | Yes | No |
| H4286 | LEON HEALTH, INC. | LMC Family Holdings, LLC | 38,877 | Yes | Yes |
| H5215 | NETWORK HEALTH INSURANCE CORPORATION | Network Health, Inc. | 77,798 | Yes | Yes |
| H5296 | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | Alignment Healthcare USA, LLC | 6,212 | Yes | Yes |
| H5431 | HEALTHSUN HEALTH PLANS, INC. | Elevance Health, Inc. | 56,202 | Yes | Yes |
| H5577 | MCS ADVANTAGE, INC. | MHH Healthcare, L.P. | 284,055 | Yes | Yes |
| H5594 | OPTIMUM HEALTHCARE, INC. | Elevance Health, Inc. | 62,883 | Yes | Yes |
Table A2: 1876 Cost Contracts Receiving the 2025 High-Performing Icon*
| Contract ID | Contract Name | Parent Organization | 10/2024 Enrollment | 5 Star Last Year |
|---|---|---|---|---|
| H5256 | MEDICAL ASSOCIATES CLINIC HEALTH PLAN | Medical Associates Clinic, P.C. | 4,536 | Yes |
| H5264 | DEAN HEALTH PLAN, INC. | Medica Holding Company | 12,192 | Yes |
*1876 Cost Contracts do not offer SNPs
Table A3: PDP Contracts Receiving the 2025 High-Performing Icon
| Contract ID | Contract Name | Parent Organization | 10/2024 Enrollment | 5 Star Last Year |
|---|---|---|---|---|
| S3389 | UPMC HEALTH BENEFITS, INC. | UPMC Health System | 1,474 | No |
| S4501 | INDEPENDENT HEALTH BENEFITS CORPORATION | Independent Health Association, Inc. | 7,329 | Yes |
Table A4: Contracts Receiving the Low Performing Icon for the 2025 Star Ratings
| Contract ID | Contract Name | Parent Organization | Reason for Low-Performance Warning | 10/2024 Enrollment |
|---|---|---|---|---|
| H0724 | BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc. | Centene Corporation | Part C or D | * |
| H2853 | CENTENE VENTURE COMPANY TENNESSEE | Centene Corporation | Part C or D | * |
| H4982 | AETNA BETTER HEALTH OF CALIFORNIA INC. | CVS Health Corporation | Part C or D | 26,484 |
| H5475 | MERIDIAN HEALTH PLAN OF MICHIGAN, INC. | Centene Corporation | Part C or D | 23,615 |
| H6713 | WELLCARE OF ILLINOIS, INC. | Centene Corporation | Part C or D | 10,819 |
| H7330 | ZING HEALTH, INC. | Zing Health Consolidator, Inc | Part C or D | 3,360 |
| H8553 | WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC. | Centene Corporation | Part C or D | 1,952 |
| S6946 | CLEAR SPRING HEALTH INSURANCE COMPANY | Group 1001 | Part D | 340,855 |
*No enrollment is showing for this contract in the CMS enrollment files. This contract only has 800 series plans for employer group enrollees.
[1] See also the Announcement of Calendar Year (CY) 2025 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies, page 130 at https://www.cms.gov/files/document/2025-announcement.pdf.
[2]https://www.federalregister.gov/documents/2020/06/02/2020-11342/medicare-program-contract-year-2021-policy-and-technical-changes-to-the-medicare-advantage-program.
[3] Percentages in the tables may not sum to 100 due to rounding.
[4] The qualifying extreme and uncontrollable circumstances for the 2023 performance period include severe storms, straight-line winds, and tornadoes in Mississippi, Typhoon Mawar in Guam, wildfires in Hawaii, and Hurricane Idalia in Florida and Georgia. See the 2025 Rate Announcement at https://www.cms.gov/files/document/2025-announcement.pdf.
[5] 42 C.F.R. §§ 422.166(h)(1)(i), 423.186(h)(1)(i).
[6] 42 C.F.R. §§ 422.166(h)(1)(ii), 423.186(h)(1)(ii).
