HEDIS Performance Takes Center Stage as 2026 Medicare Advantage Star Ratings Hold Steady
October 16, 2025
HEDIS is shifting. Stars are flattening. Advantage goes to plans that act now.
After several consecutive years of declines, the average Medicare Advantage (MA) Star Ratings are essentially flat for 2026. Similar to last year, approximately 40% of contracts earned at least 4 stars—the threshold for quality bonus payments.
While overall stability may seem encouraging, there are
notable shifts at the plan and measure level, particularly among
HEDIS-reported measures that continue to drive overall Star performance.
Key Highlights:
- High Performers See Modest Growth
CMS identified 21 plans as “high performing” for 2026, up from 13 in 2025. Of these, 18 achieved a full 5-Star Rating. The increase signals targeted improvement among select organizations, though many others experienced rating declines amid heightened measure-level volatility.
- Most HEDIS Measures Improved—With a Few Key Exceptions
Overall, most HEDIS measures posted rate increases year-over-year. However, two measures—Colorectal Cancer Screening and Plan All-Cause Readmissions—declined, likely reflecting recent changes to technical specifications and reporting criteria.
- Five Measures Fell Below 3 Stars
These low-performing areas indicate continued opportunities for improvement, especially across three HEDIS measures: - Osteoporosis Management in Women Who Had a Fracture
- Plan All-Cause Readmissions
- Follow-Up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions
- Seven Measures Exceeded 4 Stars
Among the top-performing measures, only one HEDIS indicator—Care for Older Adults: Medication Review—surpassed the 4-Star threshold. This measure continues to demo.
- Hybrid HEDIS Indicators Trending Up Ahead
All five hybrid HEDIS indicators slated for inclusion in the 2027 Star Ratings cycle increased in rate, suggesting that plans are already preparing for the upcoming retirement of hybrid methodology and strengthening data workflows. - Care for Older Adults – Medication Review: +1.42 ppt
- Eye Exam for Patients with Diabetes: +2.42 ppt
- Glycemic Status Assessment for Patients with Diabetes: +1.68 ppt
- Controlling High Blood Pressure: +2.69 ppt
- Transitions of Care: +4.29 ppt
Notably, Medication Reconciliation Post-Discharge and Care for Older Adults – Pain Assessment will be removed from Star Ratings beginning next year.
- Part C and D Measures Also Shifted: Both the MTM Program Completion Rate for CMR and Special Needs Plan (SNP) Care Management measures showed rate increases. While MTMP is being removed from Star Ratings for now (display-only in 2025–2026), it will return in 2027 as a new measure—plans should begin preparing to ensure robust performance.
Looking Ahead: The New Reality for Star Performance
- CMS projects a decline in total quality bonus payments across Medicare Advantage. As Star thresholds tighten and volatility persists, maintaining a 4-Star rating may become the exception rather than the rule. Plans that previously earned bonuses at 4 Stars may now find themselves at risk of slipping below that line.
HEDIS measures remain the most actionable lever for improving overall Star Ratings. Plans that focus now on closing measure gaps, enhancing supplemental data governance and strengthening quality oversight will be best positioned to weather the evolving measurement environment.
Ready to turn HEDIS data into results?
Advent helps Medicare Advantage plans identify their greatest opportunities, operationalize measure improvement and build strategies that deliver lasting Star gains.
Schedule a HEDIS Readiness Consultation with Advent today.
Adopting a year-round, data-driven approach, with a continued focus on quality improvement, is key to HEDIS success.”
— Jean Vertefeuille, CEO, Advent Advisory Group
Advent partners with plans to operationalize quality improvement — bridging data, compliance, and clinical workflows to drive measurable HEDIS and Star gains.
Advent Advisory Group Insights
NCQA has opened the 2026 HEDIS® Public Comment period, running from February 13 through March 13, 2026.
CMS has released its CY 2027 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies.
The CMS 2026 Program Audit Annual Updates bring several important changes that healthcare sponsors must address to stay compliant. These updates affect various aspects of the audit process, from condition classifications to new requirements for validation audits.
Aside from the usual updates to the audit timeline and other wording changes, this year’s HEDIS audit manual includes several changes of significance.
The Advent team had the opportunity to attend the NCQA Health Innovation Summit, where healthcare leaders and innovators came together to explore the next phase of digital quality measurement and value-based care.
As California leaders assess the sweeping implications of these proposed changes, Advent Advisory Group is helping health plans evaluate exposure, model financial impacts, and prepare operational strategies across Medicare, Medi-Cal, and Commercial lines.
The 2025 NCQA Health Plan Ratings are out. For health plans, these results are more than just numbers — they’re a public reflection of quality, experience, and performance.
CMS recently published its annual Part C and Part D Program Audit and Enforcement Report. The report provided recommendations and guidance for Sponsors to consider when preparing for future CMS Program Audits.
Advent’s HEDIS 2026 webinar series kicked off last month with Optimizing Clinical Data Quality, a presentation focused on common challenges with supplemental clinical data. Key takeaways include the following: Transition in Data Collection: The shift from manual data collection to digital HEDIS reporting has increased the focus on clinical data over claims data. NCQA’s planned elimination of the hybrid reporting method has added urgency to this transition, driving plans to acquire more electronic clinical data and adapt to year-round ingestion. Challenges with Clinical Data: The presentation highlighted several challenges to the acquisition of supplemental clinical data, including data timing, completeness, and accuracy. Issues such as short turnaround times, missing biometric values, and incorrect coding have impacted the useability of these additional data sources for HEDIS reporting. Tips for Navigating the Transition: Plans can navigate this transition by starting early with clinical data validation, engaging with IT departments, exploring vendor’s reports and supportive capabilities, and building executive leadership buy-in.
Another year of Medicare Part C and Part D Data Validation (DV) audits is in the books. Here are a few key takeaways and best practices from this year’s experience: 1. Share CMS Technical Specifications Early Ensure all report owners receive CMS technical specs and reporting requirements well in advance. This promotes clear understanding of required data elements and ensures alignment for HPMS submissions and audit readiness. 2. Strengthen Internal Quality Control A robust internal QC process is essential. Assign a lead to manage this effort and establish standardized checks. Block time in March to confirm that what’s submitted in HPMS accurately reflects your intended data. 3. Validate Vendor Data Throughout the Year Accurate reporting hinges on reliable vendor data. Set expectations for vendors with delegated reporting responsibilities to provide both summary and detailed data. Request clear references or documentation to interpret results effectively. 4. Create a Centralized Measure Reporting Library Maintain a central repository that includes final submissions (HPMS summary and supporting detail), measure logic, and relevant policies and procedures. These documents not only support measure reporting but also fulfill many DV audit documentation requirements. Congratulations to our Medicare clients on another successful reporting year. As always, early preparation and strong processes are the foundation of accurate reporting and DV audit success.
