It’s Too Early to Claim Victory on Raising the MA Quality Bar 

November 11, 2024

Medicare Advantage (MA) remains the only federal health care program that measures and rewards high-quality care. For the more than 33 million seniors enrolled in a plan, finding high-quality coverage is fundamental. While recent changes to the star rating program make it harder for health plans to receive quality bonuses, the changes do not necessarily improve quality.  

The MA star rating program was designed to improve health outcomes and encourage competition among plans by evaluating performance on a five-star scale. Ratings, based on factors including patient satisfaction, preventive services and chronic disease management, allowed consumers to compare quality across available options. While well-intentioned, the ratings are outdated and do not necessarily reflect the quality of care. 

Let’s begin with hard facts. Most seniors in MA will choose a 4-star plan or above – meaning a high-quality plan – in 2025. With 40 percent of all MA plans offered in 2025 being 4-stars or higher, there is justifiable concern that MA star ratings resemble an “everyone gets a trophy” system. To CMS’ credit, changes to the program made it more difficult for plans to achieve high ratings on individual measures. These incremental enhancements limited the ability of some MA plans to game the system and collect tens of millions in quality bonus dollars.  

The MA star ratings system still has plenty of room for improvement. Nearly half of the current measures remain process measures, akin to administrative tasks or simple “check the box” metrics. These measures do not provide actionable information on how well a plan is driving better patient experience and health outcomes. For example, a process measure for diabetes care could be the percentage of members with diabetes who received an annual eye exam. The outcome measure would be the rate of diabetes-related complications, such as vision loss, among members with diabetes. The process measure simply counts an action taken, while the outcomes measure assesses the effectiveness of the care in preventing complications and keeping a beneficiary healthy.  

Measures must be streamlined to focus on patient experience and positive health outcomes – information that actually matters – so seniors can make informed decisions about their coverage and care. Insurers clinging to “topped out” process measures that do not differentiate performance can score high without delivering better quality. 

ACHP’s MA for Tomorrow policy proposals raise the quality bar and modernize the stars rating, empowering seniors to make more informed choices while rewarding truly high-performing plans. It’s past time we focused on what matters to seniors – their experience and health – and prioritize these measures in star ratings. MA star ratings can be valuable tools for seniors shopping for the health plan that is right for them. We cannot be fooled when the aggregate star ratings dip and call it victory on raising the quality bar. Seniors deserve better.