US health agency releases 2026 quality ratings for Medicare plans
By Sneha SK
(Reuters) -The U.S. government on Thursday announced quality ratings for 2026 Medicare health and prescription drug plans that help determine the government’s bonus payments to health insurers.
CVS Health’s Aetna unit has more than 81% of members in top-rated programs. Regulatory agency and company figures showed UnitedHealth owns 78%, Elevance owns 55% and Humana owns about 20%.
Overall, 64% of people currently enrolled in Medicare Advantage plans that cover prescription drugs are covered by plans rated four or five stars, according to a research note from Oppenheimer.
The U.S. Centers for Medicare and Medicaid Services, part of HHS, publishes one-to-five star ratings for plans (with five being the highest performing) to help beneficiaries choose between them.
The agency evaluates different factors to rate plans, including customer satisfaction, access to care and performance on cancer screenings and management of chronic conditions.
Plans with higher star ratings mean the government makes larger payments to the insurance company, and bonus payments can be worth hundreds of millions or billions of dollars. Ratings will affect insurers’ revenues in 2027.
“Overall, the results were not particularly surprising, given the various preliminary announcements the company has made in recent weeks,” said Oppenheimer analyst Michael Wiederhorn.
CVS Health added that the Aetna business has more than 63% of Aetna Medicare Advantage members on a 4.5-star plan for next year.
Analysts said Humana and UnitedHealth’s star ratings were consistent with the companies’ previous announcements.
UnitedHealth said 78% of its members are on 4-star or higher plans and 40% are on 4.5-star plans for 2026.
Humana said last week that about 20% of its members, or 1.2 million, are in high-rate plans.
Elevance said membership in plans rated 4 stars and above has increased to 55% since 40% a year ago. Analysts said Elevance was among the top gainers in quality ratings.
Michael Carson, president and CEO of Wellcare, Centene’s Medicare business, said he was pleased with the continued progress reflected in this year’s star ratings.
“We are focused on building on this momentum by ensuring our members receive high-quality, affordable care and continuing to improve health outcomes in the communities we serve,” he said.
(Reporting by Sneha SK and Siddhi Mahatole in Bengaluru; Editing by Alan Barona)
