Medicare’s five star rating system evaluates Medicare Advantage and Prescription Drug Plans based on their performance across multiple metrics. The rating are released every year just prior to AEP, making it easier for consumers to compare plans.
How Did Plans Rate For 2026
After several years of consistent star ratings declines, the ratings show some improvement for 2026 with 18 Medicare Advantage plans earning 5 stars, an increase over a low point of seven plans in 2025. Even though more plans achieved a 5 star rating, the average star rating in 2026 is 3.66, up only slightly from 3.65 in 2025.
In Texas:
- 5 star plans are offered by Devoted Health and UnitedHealthcare
- 4.5 star plans are offered from Alignment Health Plan, Humana, KelseyCare Advantage, Prominence Health Plan and UnitedHealthcare
- 4 star plans are offered by Aetna, Baylor Scott & White, HealthSpring, Humana, UnitedHealthcare, and Wellcare.
This list does not include Special Needs Plans.
Changing Methodology
Medicare Advantage plans are rated on up to 43 unique quality and performance measures. For each measure, CMS establishes thresholds, or “cut points,” that determine whether the plan receives one, two, three, four or five stars.
CMS frequently updates their star measures by adding new measures or weighting existing measures differently. In 2026 CMS added three new measures: kidney health evaluation for patients with diabetes, improving or maintaining physical health, and improving or maintaining mental health. The weight of patient experience measures decreased, while the weight of actual outcomes increased. Some plans believe this will make it more difficult to achieve and maintain the highest star ratings.
How Ratings Impact Plans Financially
Plans that achieve 4 stars or more qualify for a quality bonus payment and greater rebate percentage. These additional revenues can be reinvested into benefits that make their products more attractive, driving enrollment and financial stability.
Plans earning less than 4 stars are at financial disadvantage and may need to increase premiums and other out of pocket costs, reduce provider networks, or cut the supplemental benefits they offer in order to compensate for reduced revenue. This in turn could negatively impact their membership numbers.
Five star plans also benefit from the 5 star special enrollment period which allows them to pick up additional membership outside normal enrollment periods.
Star Ratings Aren’t the Whole Story
Because of the small number of plans achieving 5 star status, there may be few or even no 5 star plans offered in your area. 4.5 and 4 star plans offer strong alternatives. These plans are considered “above average” and have performed well.
You can help your clients understand the importance of other factors when weighing their coverage options.
Affordability
Many members only look at the monthly premium when thinking about affordability. You can help them consider all the potential out of pockets costs including deductibles, coinsurances, and copays for both medical and prescription services.
Provider Network
It’s important to find a plan that has all of their preferred medical providers in the network. This includes their primary care doctor, specialists, and hospitals. If they travel outside their local service area for extended periods of time, they might want to consider a PPO plan, but there are fewer of these available in 2026 and they come with higher costs.
Prescriptions
It’s important to find a plan that covers all of their prescription medications. Drug formularies can vary not only by insurer but by plan type. A carrier might offer either a standard formulary or an enhanced formulary, depending on the plan. Confirm any out of pocket costs, including deductibles, copays, or coinsurances. Check for other requirements such as prior authorizations, step edits, or quantity limits.
Supplemental Benefits
Does your client want a plan that offers dental, vision, or hearing benefits? Is a gym membership a “must have”? Many Medicare Advantage plans have trimmed or even eliminated some of their supplement benefits as cost saving measures. You might need to help your client decide which benefits are the most important to them.
You Play an Important Role
As an experienced and knowledgeable Medicare agent, you are the best resource to help your clients understand Medicare’s star ratings and help them evaluate all the factors involved with choosing the right coverage..
The dedicated team at PTT Financial is here to support you and help you grow your business. Learn more.