Medicare Advantage Star Ratings can affect plan funding, benefits, and the conversations agents have with clients.
For 2026, the number of Medicare Advantage contracts earning 4 or more Stars fell from 261 to 207.
That raises an important question:
“Did these plans suddenly get worse?”
In the latest episode of The Insurance Producers Guild, we explain why the answer is more complicated.
Listen here: EP18: Why Medicare Advantage Star Ratings Fell for 2026
Medicare Advantage Star Ratings are not based on a fixed grading scale.
CMS recalculates rating cut points each year. Measure weights can change, industry performance can improve, and temporary policies can expire.
That means a plan may perform similarly from one year to the next and still receive a lower rating.
For agents, this matters because clients may assume:
A lower rating deserves attention.
It does not automatically mean a client should change plans.
In EP18, we discuss:
The key message is simple:
The rating may have changed because the scoring system changed—not because the plan suddenly stopped performing.
Plans earning at least 4 Stars may qualify for Quality Bonus Program payments.
These dollars can help support benefits such as:
Total bonus spending increased to approximately $13.4 billion for 2026, but those dollars are now concentrated among fewer contracts.
That does not mean every lower-rated plan will reduce benefits.
It does mean agents should closely review finalized premiums, copays, networks, formularies, and supplemental benefits.
A Star Rating should never replace a complete needs assessment.
Before recommending a change, agents should compare:
A higher-rated plan is not automatically the best fit.
A lower-rated plan may still serve a client well.
Clients may hear about lower ratings through ads, carrier notices, or the news.
A clear response might be:
“CMS updates the Star Rating methodology each year. A lower rating does not automatically mean your plan is no longer a good fit. Let’s review your doctors, prescriptions, benefits, and costs before making any decisions.”
The goal is not to defend a carrier.
The goal is to help the client make an informed decision.
Do not wait until enrollment season becomes crowded.
Review clients whose contracts experienced a rating change and confirm:
Document each review in your CRM and focus on suitability—not switching for the sake of switching.
PSM Brokerage helps independent agents prepare for Medicare Advantage changes with:
Because independent should not mean unsupported.
Hear the full conversation here:
Listen to EP18: Why Medicare Advantage Star Ratings Fell for 2026
A lower Star Rating can create concern, but it should not create panic.
Review the complete picture.
Check the benefits. Verify the doctors. Review the prescriptions. Compare the costs.
Then make a recommendation based on what is best for the client.
PSM Brokerage gives independent agents access to products, technology, training, marketing support, and experienced guidance.
Connect with PSM Brokerage today.