Star Ratings Stable For SY 2026
Despite the government shutdown, the Star Year 2026 Ratings data tables are out. The three-year downturn in Star ratings appears to have ended, but SY 2026 was relatively flat to SY 2025. The average Star rating moved from 3.65 in SY 2025 to 3.66 in SY 2026.
Of the 481 MA contracts rated in both SY 2025 and SY 2026, about 29% (140) of contracts saw ratings drop a half a Star or more, 26% (125) of contracts saw ratings increase a half a Star or more, and about 45% (216) stayed the same.
The number of contracts at 4 and greater is about the same at just over 200. I suspect enrollment in these plans is about the same too, which was about 64% in 2025. But about a quarter of contracts at 4 or greater are different.
As in the past there was volatility among the high performers. From SY 2025 to SY 2026, there were 36 new contract entrants to the exclusive category of 4.5 and 5 (91 contracts), while 38 contracts dropped out. Of those in the club before, 7 went up and 5 down.
What happened with the big players?
- UnitedHealthcare 4 Star plus enrollment went up from 71% to 78%.
- Humana 4 Star plus enrollment went down from 25% to 20%.
- Elevance Health 4 Star plus enrollment went up from 40% to 45%.
- Centene saw its 4 Star plus enrollment go from about 0% to 20%.
In general, the big plans remain in the Star doldrums compared with past performance.
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#stars #medicareadvantage #quality #cms
Democrats May Agree To Exchange Credit Cap
Some moderate Senate Democrats say they are open to placing an income cap on eligibility for Exchange enhanced premium subsidies to help facilitate a deal with Republicans.
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#exchanges #healthcare #coverage
https://www.axios.com/2025/10/08/democrats-income-cap-aca-subsidies
BCBS Cutting Staff Through Separation Package
Blue Cross Blue Shield of Massachusetts (BSBSMA) is offering a voluntary separation program to about 18% of its employees. This will cover almost 800 people. Employees who are at least 55 years old and have worked for the organization for a minimum of 10 years are eligible.
BCBSMA has been struggling financially, with a net loss of $223.6 million and a -4.3% operating margin in 2024.
Additional article: https://www.beckerspayer.com/workforce/bcbs-massachusetts-offers-buyouts-to-18-of-workforce/
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#bcbsma #margins #healthplans
Government Shutdown Update
The Senate yet again voted down a GOP bill to reopen the government. The same number of Democratic caucusing senators supported the GOP measure but 60 votes were not attained.
Democrats say they are winning the political battle here by standing up for healthcare. While an earlier poll showed Americans roughly divided on who to blame, a CBS News poll found 39 percent of respondents holding Trump and Republicans accountable vs. 30 percent who blame Democrats.
House Minority Leader Hakim Jeffries, D-NY, defended Democrats’ rejection of a one-year extension of enhanced Exchange subsidies, while a prominent conservative congressman said Republicans are running scared on the issue.
Additional article: https://thehill.com/homenews/house/5547218-chip-roy-republicans-health-care-reform/
#governmentshutdown #congress #trump #exchanges #healthcare #coverage
Premiums Up Due To GLP-1s
An analysis by the Employee Benefit Research Institute finds that premiums for employer coverage could increase between 5% to 14% due to the uptake of GLP-1 weight-loss drugs. About 55% of employers cover GLP-1s for diabetes and 36% cover them for both diabetes and weight loss.
#glp1s #weightlossdrugs #drugpricing
https://www.beckerspayer.com/research-analysis/covering-glp-1s-could-raise-premiums-by-14-study/
— Marc S. Ryan
