Humana’s Medicare Advantage star ratings slip for 2026

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Humana can have 20% of its Medicare Benefit members in plans rated 4 stars or above in 2026, down barely from 2025 however according to inside expectations, the insurer disclosed Thursday.
Humana — the second largest MA provider within the nation — did see an enchancment in members in plans rated 4.5 stars or above. Subsequent 12 months, 14% of Humana’s MA members might be in these extremely rated plans, up from 3% in 2025.
Humana’s common star score of three.61 is roughly secure 12 months over 12 months. The insurer, which has been working to enhance its rankings, mentioned it was unhappy with the outcomes. Nonetheless, Humana’s inventory rose about 3% in Thursday’s commerce following its disclosure.

It’s busy season for insurance coverage market watchers, with the CMS releasing extra data on the Medicare Benefit panorama for the approaching 12 months — together with by mistake.

On Wednesday, regulators revealed extra detailed data on MA plan choices for 2026 and inadvertantly launched some star rankings information, main Humana to file its personal disclosure to buyers, the insurer mentioned.

Although Humana’s common star score remained basically unchanged, the outcomes are total probably disappointing for the insurer. That’s as a result of the share of MA members in plans rated 4 stars or larger dropped from 25% this 12 months.

To place that additional into context, Humana had 94% of members in plans rated at the very least 4 stars in 2024.

Reaching that threshold is vital for insurers within the privatized Medicare program. Plans that obtain an total score of 4 or larger obtain larger bonus funds. Larger scores additionally end in bigger rebates if plans submit bids beneath the CMS’ benchmark for the approaching 12 months.

Humana expects to lose billions of {dollars} in income on account of the star rankings drop from 2024 to 2025, so an extra dip for 2026 gained’t assist.

“Whereas the Firm is just not happy with its 2026 Star Scores, it’s happy with the tactical operational enhancements made throughout the last months of the 2026 measurement interval, making a stable basis for the Firm’s anticipated return to Prime Quartile outcomes for the 2027 Star Scores,” Humana mentioned in its securities submitting

Together with suing the federal government in a bid to enhance its scores, Humana has hustled to enhance its rankings by closing gaps in care, growing member outreach and investing in know-how, in keeping with govt feedback.

The insurer has additionally pursued a method known as “contract diversification.”

The CMS measures high quality by star rankings on the contract degree fairly than on the degree of a person plan. One contract can embrace many various plans. Because of this, by juggling member enrollment in sure plans and plan attribution to sure contracts, Humana can transfer extra members into extra extremely rated contracts and safe the upper per-member payouts that gives.

Together with contract diversification, Humana has stopped paying commissions to brokers for one-third of its merchandise, in keeping with a analysis notice from funding financial institution TD Cowen. Reducing commissions to 3rd events that assist seniors enroll in protection is one other technique from insurers to steer members into extra worthwhile or extremely rated plans.

Because of its efforts, Humana expects the share of its members in plans rated at the very least 4 stars might be “meaningfully larger” than 20% in 2027, in keeping with the insurer’s submitting.

Main publicly traded insurers are at the moment prioritizing income over progress in MA after two years of seeing shrinking margins within the once-lucrative program. Seniors have been consuming extra medical care than insurers anticipated, inflicting bills to skyrocket, whereas regulatory adjustments have cracked down on reimbursement.

The three largest MA carriers, together with Humana, all trimmed the variety of states and counties they serve for 2026, in keeping with an evaluation of CMS information launched Wednesday. Nonetheless, Humana stored its plan advantages comparatively secure, a choice that’s fearful some buyers given it’d appeal to many new members to Humana’s plans, together with some that would saddle the payer with larger medical prices.

Total, the Louisville, Kentucky-based payer expects to double its pre-tax margin in particular person MA plans subsequent 12 months, excluding the affect of star rankings, in keeping with the disclosure.

UnitedHealthcare, the biggest MA provider within the U.S., additionally disclosed some stars outcomes early this 12 months. In September, the UnitedHealth-owned insurer mentioned it will have roughly 78% of its MA enrollees in plans rated 4 stars or larger, largely flat 12 months over 12 months.

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