The 2026 CMS star ratings are now available for Medicare Advantage (MA) carriers. Some carriers are pleased; others are not.
Why are these ratings so important to the carriers? It’s all about the money.
CMS will pay carriers with a contract that achieves a 4-star rating or higher a Quality Bonus Payment (QBP) of approximately 5% of their benchmark, which may vary by county or other factors. CMS also allows 4-star or higher contracts to retain 65-70% of their rebates, compared with 50% for contracts rated below 4 stars.
This rebate typically funds the supplemental benefits for which MA plans are known today. The higher the rebates you retain, the more supplemental benefits the carrier can offer.
This year, the QBP alone will be nearly $13 billion, and plans receiving this bonus will cover about 75% of MA members. MA members and Medicare prospects follow the money because it delivers the health benefits they want.
Money is driving happiness or unhappiness with your MA carriers as these payments directly impact their ability to provide significant benefits and services, or not. Agility encourages all Medicare agents to review the ratings in the article linked at the top and determine where each of your carrier partners currently stands.
This information will affect revenue across most aspects of their business, including the benefits, services, and care they deliver to your clients, as well as the services and commissions they offer you and your team. Remember, MA carriers with 4 or fewer stars in their contracts will receive less revenue from CMS than carriers with 4 or more stars in their MA contracts.
Agents can view the complete, current MA star ratings in the MA contract list for more details on how their MA plans are performing.
There’s a lot of information to digest about these ratings, so our Medicare product expert, Scott Meeks, is here to answer any questions you have about the 2025 MA star ratings. You can schedule an individual meeting with Scott.
Scott can also walk you through any Medicare contracting questions you have for AEP, and connect you with the right tools to reach your clients. You can schedule this meeting through the Agility Producer Support Team at (866) 590-9771 or by email at support@enrollinsurance.com.
And you can sign up for our free weekly email list to receive timely updates and expert tips designed to help you maximize your Medicare AEP.
