Humana’s Medicare Advantage star ratings slip for 2026

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Humana may 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 yr, 14% of Humana’s MA members might be in these extremely rated plans, up from 3% in 2025.

Humana’s common star ranking of three.61 is roughly secure yr over yr. The insurer, which has been working to enhance its scores, stated 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 yr — together with by mistake.

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

Although Humana’s common star ranking remained primarily unchanged, the outcomes are total doubtless 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 yr.

To place that additional into context, Humana had 94% of members in plans rated a minimum of 4 stars in 2024.

Reaching that threshold is essential for insurers within the privatized Medicare program. Plans that obtain an total ranking of 4 or larger obtain larger bonus funds. Larger scores additionally lead to bigger rebates if plans submit bids beneath the CMS’ benchmark for the approaching yr.

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

“Whereas the Firm isn’t happy with its 2026 Star Rankings, it’s happy with the tactical operational enhancements made through the remaining months of the 2026 measurement interval, making a stable basis for the Firm’s anticipated return to Prime Quartile outcomes for the 2027 Star Rankings,” Humana stated in its securities submitting

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

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

The CMS measures high quality by way of star scores on the contract stage quite than on the stage 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, based on a analysis be aware 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.

On account of its efforts, Humana expects the share of its members in plans rated a minimum of 4 stars might be “meaningfully larger” than 20% in 2027, based on the insurer’s submitting.

Main publicly traded insurers are at present 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 modifications 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, based on 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 entice many new members to Humana’s plans, together with some that would saddle the payer with larger medical prices.

General, the Louisville, Kentucky-based payer expects to double its pre-tax margin in particular person MA plans subsequent yr, excluding the affect of star scores, based on the disclosure.

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

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