5.0 Star Contracts in the Medicare Advantage Program: Is There an Enrollment “Advantage”?

On October 8, 2021, CMS published the 2022 Medicare Advantage (MA) and Part D Star Ratings, which influence 2023 payment year Quality Bonus Payments (QBPs). The 2022 Star Ratings reflect a historic prevalence of top performing contracts. In fact, more contracts achieved a 5.0 Star Rating than in any previous year. Although there is no differentiation in QBP level between 4.5 and 5.0 stars for MA plans, there is a unique advantage of achieving 5.0 Stars. 5.0 Star plans are eligible to market their plan offerings year-round via a Special Enrollment Period (SEP). Beneficiaries that have a 5.0 Star plan in their service area are eligible to switch plans once at any point during the year only if the new plan is rated 5.0 Stars.

In 2022, the number of Medicare Advantage contracts that received a 5 Star Rating grew 252%, opening an unprecedented opportunity for mid-year growth for 5 Star Rated Contracts in 2022. This article explores the potential disruption and opportunity that the unprecedented 2022 Star Rating performance could drive.