US health agency releases 2026 quality ratings for Medicare plans

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By Sneha S K

(Reuters) -The U.S. government announced quality ratings for 2026 Medicare health and prescription drug plans on Thursday, which help determine bonus payments from the government to health insurers.

CVS Health’s Aetna unit has more than 81% of members in top-rated programs. UnitedHealth has 78%, Elevance 55% and Humana about 20%, figures from the regulator and companies showed.

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 & Medicaid Services, which is part of the HHS, issues star ratings for the plans from one to five — with five being the highest performing — to help beneficiaries choose among them.

The agency evaluates different factors to rate the plans, including customer satisfaction, access to care and performance on cancer screenings and management of chronic conditions, among others.

Plans with higher star ratings mean bigger payments from the government to the insurer, and the bonus payments can be worth hundreds of millions or billions of dollars. The ratings will impact insurers’ revenues in 2027.

“Overall, the results were not very surprising given the various company pre-announcements over recent weeks,” said Oppenheimer analyst Michael Wiederhorn.

CVS Health added that its Aetna business also has over 63% of Aetna Medicare Advantage members in a 4.5-star plan for next year.

Humana and UnitedHealth’s star ratings were in line with the companies’ earlier announcements, analysts said.

UnitedHealth said that it has 78% of its members in 4-star plans or higher and 40% are in 4.5-star plans for 2026.

Humana said last week that it has about 20%, or 1.2 million, of its members in high-rated plans.

Elevance said it now has 55% of membership in plans rated 4 stars and higher, up from 40% a year ago. Elevance was among the largest gainers in quality ratings, analysts said.

Michael Carson, the 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’re focused on building on this momentum, ensuring our members receive high-quality, affordable care and continuing to improve health outcomes in the communities we serve,” he said.

(Reporting by Sneha S K and Siddhi Mahatole in Bengaluru; Editing by Alan Barona)