Dive Brief:
UnitedHealth and Centene have received a valuable boost in their Medicare Advantage star ratings for 2025 after squaring up against federal regulators in court.
The CMS increased stars for 12 UnitedHealth contracts and seven Centene contracts in revised ratings released Monday. UnitedHealth had three more contracts reach the all-important four star threshold, giving them access to lucrative bonuses for the first time, while two contracts were upgraded to the highest possible rating of five stars, garnering the maximum rebate from the federal government.
Meanwhile, Centene had one contract bumped to four stars — the insurer’s only contract for 2025 to reach that threshold. Two contracts were increased from 2.5 to 3 stars, which is important as plans that consistently score below three stars are prevented from expanding and could face termination from MA.
Dive Insight:
Many health insurers cried foul when the CMS released star ratings for 2025 in October. Regulators tightened standards for reaching the highest scores, resulting in a small dip in stars across the board. That translates to serious financial repercussions for some insurers, given the stars have a direct impact on plans’ reimbursement in the privatized Medicare program.
A number of insurers sued, including UnitedHealth, Centene, Humana, Elevance and Blue Cross Blue Shield of Louisiana. At least one of those lawsuits has now borne fruit, after a federal judge late last month ordered the CMS to recalculate UnitedHealth’s ratings, finding regulators unfairly assessed the insurer’s customer service call center.
Following the CMS’ revisions on Monday, UnitedHealth and Centene should now have 6% and 1% more members in plans rated four stars or higher, respectively, according to TD Cowen analyst Ryan Langston. Based on the insurers’ Medicare memberships as of the third quarter, that equates to roughly half a million individuals for UnitedHealth and just upwards of 10,000 individuals for Centene.
The CMS didn’t just bump the stars for insurers that have won legal battles, however, as Centene’s lawsuit is ongoing. Other insurers that have filed suit — notably, Elevance, BCBS of Louisiana and Humana — did not see their scores improve.
One BCBS of Louisiana contract actually had its Part C star rating decrease, from 4 to 3.5 stars, though its overall star rating did not change. (The only other contract that saw a shift in scores, CommunityCare Senior Health Plan run by Oklahoma systems Ascension Saint John and Saint Francis Health System, had its Part C rating increase to 4.5 stars but its final score also stayed the same.)
A spokesperson for the agency said the CMS does not comment on active litigation when asked why regulators elected to update the 2025 stars.
However, the revisions, along with Elevance’s success in court in a lawsuit over 2024 ratings earlier this year, bodes well for other insurers seeking a touch-up for their scores.
Humana could particularly benefit from further revisions, after the Louisville, Kentucky-based insurer saw its ratings plummet for 2025. Only 25% of Humana’s MA members will be in a plan with four stars or above next year, down from 94% this year. The drop could cost Humana upwards of $1 billion in revenue in 2026.
On a call Tuesday to discuss Humana’s CFO transition, management said they didn’t know why UnitedHealth and Centene’s stars had increased but that they were talking with the CMS to understand, according to analysts on the call.
Medicare’s annual enrollment period concludes on Saturday.
