Are Medicare Advantage plans getting worse, actually?

Sidewalks on famous boulevards, military heroes, well-behaved school children, and Medicare Advantage plans all have one thing in common: They’re decorated with stars to represent success. While just about everyone can understand how to earn a star in a first grade classroom, it might not be as obvious how Medicare Advantage stars are determined each year. And even less obvious how those stars translate to sales tactics for the health insurance agent.

But the recalibration of the star rating system has dramatically reduced the number of five star plans this year. And that is taking into account the fewer number of plans offered this year. Let’s explore 2025 star ratings and determine if private Medicare plans are getting worse, actually.

Star Ratings in 2025

Agents already know what star ratings do and what they are for. But changes to the way star ratings are calculated has reduced the number of five star plans across the board. Unfortunately, 2025 will keep the status quo of 2024: Michigan, and many other areas, will go another year without a five star plan. This means groups of agents will see another year without a five star plan change option. This, as you know, is one of the few reasons outside of an SEP for a plan change outside of AEP.

Across the country, there are 11 plans total with a five star rating: seven MA-PD plans, two 1876 cost contract plans, and two PDP plans. That’s quite a drop from the 38 MA-PD plans that were five star last year, but the PDP total remains steady for the third year.

Without further adieu, here are the star ratings for 2025.

*Overall star ratings are weighted by enrollment.

*Overall star ratings are weighted by enrollment.

Surface level take

So if you just read across the first row and call it a day, then yes. MA-PD plans are getting worse, actually, and PDPs are staying put after having their reckoning a few years back. There are fewer five star plans than ever before. Average ratings dropped for both plan types, even as the number of plans dwindled.

Plans earmarked as low performing are growing in numbers, too. Two more plans have been added to that low-performing list, making the grand total a record-breaking eight plans across both plan types. And to top that all off, 340,000 people are on just one of those low performers.

The story doesn’t look good if you focus on the two extremes.

The in-betweens

But it's not all bad, really. Unless you analyze the data further, it’s hard to get a true picture of how these ratings play out in practice.

Sure, there are only 11 plans at the top. But the number of middle of the road plans grew in both the MA-PD and PDP space. This means many of those once five star plans were probably not yanked from the market but simply knocked down a half star when the new guardrails were put into place.

All this downshifting at the top did not trickle down equally. The total number of plans rated two stars and below dropped pretty significantly in both spaces, too. Many lower performing plans were the ones on the chopping block in 2025.

It’s also helpful to look at data points absent from this chart: The number of people who are able to enroll in these plans. If there are only 11 plans across the board with five stars, there are huge gaps where people are not able to enroll in the highest-quality plans.

Approximately 40% of plans available in 2025 have four stars or more. That’s only 2% less than in 2024. And if enrollment pans out similarly, 62% of MA-PD enrollees will be in a plan with four or more stars.

The numbers aren’t quite as good for PDPs, though. 27% of PDP contracts hit that 4 star or higher mark, and only 5% of enrollees are in contracts with four or more stars in 2025.

So why is it like this?

Depends on who is giving the answers. If you ask CMS, they will say they keep tweaking the rules to best measure what matters most to beneficiaries. Particularly this year, the tweaking removed a lot of what CMS considered to be “outlier” data—meaning anything making a plan look too good or too bad.

For example, one fairly new MA-PD rating category is “All Cause Readmissions.” This category measures how well a plan ensures beneficiaries don’t wind up in the hospital a second time after being admitted the first time. Because it was a new measurement, it was weighted less heavily. But this year is the first year that it is now weighted similarly to other counterparts. We can assume this affected overall ratings, and plans will react accordingly in the next few years to accommodate this change.

CMS also focuses more in the past years on the member services aspect, weighing it more heavily than others. This requires carriers to listen to feedback and change what beneficiaries didn’t like about the plans for future years.

And you know which plans are having the easiest time doing that? The ones that have been around the block a few times. Over half the plans with three plus stars have been around for ten years or more. 71% of the five star MA-PD plans have seen a decade’s worth of enrollments. New plans are having a hard time keeping up.

These changes over time put a lot of plans up somewhere in the middle of the rating system. But that might be because the plan isn’t designed to be balanced. What if a plan is meant to focus on one type of beneficiary? What if a plan had a particular type of beneficiary in mind? That could affect the star rating of that plan.

Lack of provider availability, maybe, in a particular area might lead to lower ratings. A plan in a rural area might not keep wait times as low as a bustling city with lots of options. One example even led to a lawsuit filed against CMS for lowering a plan’s star rating from four to five. Why? A French translator was not able to connect with the caller within eight minutes. There are other examples, but these are just a few that might sway a star rating to make a plan look worse than it really is.

What do I do as the agent?

These star ratings are helpful for a bird’s eye view, sure. And it can be a quick tidbit to throw at your client when helping weigh their options. “It’s a four and a half out of five stars!” But the thing is, that’s probably all your beneficiary will bother to understand about those ratings.

The real meat and potatoes of why a client might choose one plan over another lies in the details of the plan itself, those 30-40 measurements making up the overall score. Sure, the average plan only scores a 2.6 in reducing the risk of falling, which doesn’t sound good. But if your beneficiary is a marathon runner who freshly turned 65, that doesn’t matter to him. He probably cares more about the preventative screening and pain assessment scores on that plan.

At the end of the day, its up to you to listen to the needs of your client and find the plan that fits them just right. As was the case with our marathon runner above, It may be that a plan with the right combination of sub scores is better fitting than a plan with a higher overall score.