Star Ratings + Payment: What Just Happened, and Why It Matters

A lot happened last week between Friday’s final rule and Monday’s CY 2026 Rate Announcement—especially for those of us navigating the Stars and quality landscape in Medicare Advantage. Here are a few highlights and takeaways that caught my eye:

1. Breast Cancer Screening (BCS) Age Expansion The age range for BCS is expanding from 50–74 to 40–74, which has implications down the road. While this change won’t hit Star Ratings until 2029, it will be on display starting in 2027. Plans with significant dual-eligible populations under 65—particularly those in D-SNPs—should get curious now: how is your 40–49 population performing in BCS? This may be a new area of vulnerability.

2. HEI is now EHO4all CMS is rebranding the Health Equity Index (HEI) as “Excellent Health Outcomes for All” (EHO4all). While it sounds more poetic than technical, the structure and intent remain: incentivize quality performance in high-risk populations. Despite speculation that this reward might disappear, it’s likely still cost-saving for CMS—so for now, it stays. Plans should continue treating this as a serious strategic priority.

3. Data Disputes: Don’t Wait for Plan Preview CMS reiterated the importance of early review and dispute of measure-level data—long before the August/September plan preview periods. For 2026 Star Ratings, key deadlines for CTM (May 30, 2025) and appeals data (June 30, 2025) have already been announced. Plans should operationalize an internal process now to review source data proactively and flag discrepancies before the windows close.

4. What That 5.06% Payment Increase Really Means CMS finalized a +5.06% average increase in Medicare Advantage payments for 2026—more than double the +2.23% proposed in January. What changed?

The biggest driver was an updated Effective Growth Rate, which jumped from 5.93% to 9.04%. That’s CMS’s estimate of how much more expensive it is to care for FFS beneficiaries—a proxy for underlying medical inflation and utilization trends. In short, FFS costs are climbing faster than expected, and that flowed through into higher MA benchmarks.

While lobbying doesn’t technically affect the math, it does shape the narrative and pressure environment. Industry pushback on payment cuts—particularly in an election year—likely helped ensure CMS fully incorporated the newest FFS data and applied no additional downward pressure.

5. How MA Plans Should Use the Extra Revenue Yes, this is a financial win for MA plans. But it’s also a responsibility. These dollars are intended to be reinvested in Medicare Advantage beneficiaries—typically through enhanced benefits, reduced premiums, and supplemental services.

And that brings me to my final point: play the long game. Rates go up. They also go down. Reimbursement volatility is a given in MA. But Star Ratings—and the QBP dollars they bring—are a multi-year endeavor.

So rather than chasing shiny new benefits that might be unsustainable in a leaner year, I’d encourage plans to prioritize long-term strategies:

• Invest in CAHPS and the member experience

• Improve HOS and member health outcomes

• Close HEDIS and adherence gaps

• Build sustainable partnerships and internal infrastructure

Because in this space, the most powerful lever you have is a healthy, engaged member—and the most lasting strategy is a high and stable Star Rating.