Cut through the noise, find the signal: Intelligence for serious healthcare leaders
How CMS grades MA plans, what each measure is worth, and where the money moves.
Aggregate performance across all MA-PD contracts. Note the 2022 COVID peak and the correction after it.
| Year | Avg rating | % contracts 4+ | % enrollment 4+ | 5-star plans | Notes |
|---|---|---|---|---|---|
| 2026 | — | — | 63.5% | 34 | CAHPS/Access weights drop 4→2. HOS measures return. 34 five-star plans. |
| 2025 | 4.17 | 40% | 62% | 7 | 5-star contracts drop to just 7. Readmissions weight rises to 3. |
| 2024 | 4.04 | 42% | 68% | 38 | Tukey outliers implemented. Cut points shift upward. |
| 2023 | 4.15 | 51% | 70% | 30 | Pandemic flexibilities removed. Sharp decline from 2022 peak. |
| 2022 | 4.37 | 68% | 90% | 52 | COVID PEAK. "Better of" methodology inflates ratings dramatically. |
| 2021 | 4.10 | 49% | 80% | 11 | COVID scoring rules continue. QBPs reach $11.6B. |
| 2020 | 4.06 | 52% | 74% | 15 | COVID begins. 2019 CAHPS data carried forward. |
| 2019 | 4.09 | 49% | 73% | 14 | Medication Reconciliation Post-Discharge added. |
| 2018 | 4.08 | 47% | 71% | 14 | Hold Harmless introduced. Statin Therapy added. |
| 2017 | 4.06 | 49% | 68% | 14 | CAI implemented. Stable performance. |
| 2016 | 4.02 | 46% | 70% | 12 | Pure clustering adopted. Low Performing Icon begins. |
| 2015 | 4.04 | 47% | 62% | 14 | Average crosses 4.0 for first time. |
| 2014 | 3.86 | 42% | 56% | 12 | Final year of QBP Demo. |
| 2013 | 3.70 | 40% | 52% | 10 | QBP Demo continues (3+ stars get bonus). |
| 2012 | 3.18 | 27% | 30% | 7 | QBP & QBP Demo begin. First year of bonuses. |
Year-over-year change in plan payments attributable to Star Ratings changes. Negative values mean fewer plans qualifying for bonuses.
Average ratings rose from 3.18 to 4.04 as QBP incentives drove plan quality investments. The industry quickly learned that Star Ratings determine billions in bonus payments.
Ratings stabilized around 4.0–4.1 as the industry reached equilibrium. Most plans that could achieve 4+ stars had done so; further gains required more structural investment.
Pandemic scoring rules artificially inflated ratings. In 2022, 90% of enrollees were in 4+ star plans and 68% of contracts qualified — both all-time highs driven by the “better of” methodology, not genuine improvement.
COVID flexibilities removed, Tukey outliers shifted cut points upward, and CAHPS/Access weights dropped 4→2. Five-star contracts plummeted from 52 (2022) to 7 (2025) before rebounding to 34 (2026). The industry is recalibrating to a harder ratings environment.