Humana sues over 2025 Medicare Advantage Star Ratings
UnitedHealth has also filed a lawsuit, and Elevance says it is considering its options.
Photo: Raymond Gehman/Getty Images
Humana has sued the Centers for Medicare and Medicaid Services over the results of the 2025 Medicare Advantage and Part D Star Ratings.
Humana and nonprofit trade association Americans for Beneficiary Choice filed the complaint on October 18 in federal court in the Northern District of Texas against CMS, the Department of Health and Human Services, HHS Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure.
The case centers on cut points, the upper and lower thresholds for each measure, which determine a plan's overall score, from 1-5 stars.
Also, CMS did not follow its own ground rules on decision-making and failed to provide needed data, the complaint said.
Humana said that, while the case may appear to be "a dry disagreement over technical details. It is anything but."
"Star ratings are tremendously important to the operation of the MA and Part D programs," Humana said in the complaint.
Star ratings provide agents, brokers and Medicare beneficiaries with information about a plan's quality, enabling them to compare plans when shopping during the annual enrollment period.
"In addition, CMS must provide quality bonus payments – in amounts that can reach hundreds of millions or even billions of dollars annually – to plans with better star ratings," Humana said. "Plans must then use those payments either to lower costs for their enrollees or to provide them with additional benefits."
Humana asks for CMS to retract and recalculate "unlawful" star ratings in mid-contract year, as it did with 2024 star ratings with SCAN Health Plan.
Humana wants CMS to vacate 2025 star ratings and remand the matter for recalculation.
WHY THIS MATTERS
"The stakes hardly could be higher," Humana said, since for the first time last year, the number of beneficiaries enrolled in MA surpassed traditional Medicare. "It is now a half-trillion-dollar public benefit program," Humana said.
Humana follows UnitedHealth Group in filing a lawsuit against CMS and HHS over the star ratings results. Elevance has also said it is considering its options.
All of the insurers cited a change in cut points as a major reason for their plans receiving lower star rating this year over last.
Cut points for several measures "moved abruptly and substantially upward, significantly depressing MAOs' Star Ratings, including Humana's," Humana's lawsuit said. "Under the 2024 Ratings, 94% of Humana's MA enrollees were in a plan with 4.0 Stars or higher. As a result of the unexplained swings in the most recent cut points calculated by CMS, now only 25% of its enrollees are in plans rated 4.0 stars and above for 2025."
Also, CMS failed to disclose the data needed for Humana to validate the cut points.
In addition, an Accuracy & Accessibility Study, in which CMS call "surveyors" place test calls to evaluate centers' compliance with regulatory requirements, lowered the star ratings for at least a dozen of Humana's largest plans on the basis of just three phone calls that were handled by CMS in a manner inconsistent with the agency's own regulations, Humana said.
THE LARGER TREND
Only seven plans received 5 stars for Parts C and D performance in the 2025 Medicare Advantage and Part D Star Ratings released by Centers for Medicare and Medicaid Services on October 10.
This compares to 38 contracts that received 5 stars in 2024.
More plans this year received 4.5 stars than last year, 86 for 2025, compared to 81 in 2024. The number of 4-star plans saw a drop to 116 this year from 123 last year.
Email the writer: SMorse@himss.org
