This is Jacob Emerson with the Becker's Payer Issues Podcast. Here is your biweekly industry news briefing for October 14th. Average Medicare Advantage star ratings declined for the 3rd year in a row according to new CMS data published on October 10th. The average MA star rating for 2025 is 3.92 stars. That's down from 4.07 in 2024. Plans must earn a rating of 4 or higher to receive bonus payments from CMS. 2025 star ratings affect the quality bonus payments plans receive in 2026.
Just 7 plans received a 5 star rating in 2025. That's down from 38 in 2024. Around 40% of Medicare Advantage Part D plans received 4 stars or higher. Around 62% of MAPD enrollees are in plans rating rated 4 or higher. CMS did not make any major changes in star ratings methodology. Medicare Advantage Part d plans are rated on 40 clinical quality and member service measures. CMS determines cut points for each per measure
each year. For 2025, many cut points increased, meaning plans had to perform better to get higher star ratings. Several factors influenced the tougher cut points. The agency removed extreme outliers from the lower end of performance, a more compressed distribution on scores, and an increasing number of high scoring contracts. Potential challenges to CMS's star ratings could loom. Earlier in October, Humana said its star ratings
for 2025 dropped significantly from last year. For next year, just 25% of Humana's members will be in contracts rated plans 4 stars and above. That's down from 94% in 2024. UnitedHealthcare is also challenging CMS's star ratings. The company filed a lawsuit September 30th challenging CMS's inclusion of a secret shopper phone call in its star ratings that UnitedHealthcare said never connected. Back in June, CMS recalculated 2024 star ratings for all Medicare Advantage plans.
Judges sided with Scan Health Plan and Elavance Health in lawsuits challenging the methodology CMS used to calculate the ratings. In addition to determining bonus payments, star ratings guide beneficiaries' decision on which plans to enroll in. Open enrollment begins October 15th. Well, CMS is proposing new regulations on the ACA marketplace in 2026, which includes some aimed aimed at cracking down on fraud. The agency published its proposed rules for the marketplace October 4th.
It proposed holding lead agents at insurance agencies accountable for violations of marketplace standards. The agency also proposed using its authority to suspend an agent or broker's ability to operate on the exchange if the agency deems the agent poses an unacceptable risk to marketplace operations. The policy would improve security on the exchange resulting in fewer unauthorized changes to coverage.
CMS has moved to crack down on brokers making changes to enrollees coverage without their knowledge. In the 1st 6 months of this year, CMS said it received nearly 74,000 complaints about a plan being changed without the enrollees consent and nearly 130,000 complaints about individuals being enrolled in plans without their knowledge. CMS has suspended at least 200 marketplace agents for reasonable suspicion of fraud since June.
The proposed rules would also add a new model consent form designed to help agents and brokers better document a customer's consent to enroll in a plan or change their coverage. The agency is also proposing allowing insurers to implement fixed dollar or percentage based thresholds to allow individuals to maintain their coverage even if they have not paid their full monthly premium. The agency proposed capping that amount at $5 or less.
CMS has also proposed several updates to the risk adjustment program, which spreads out costs between insurers in state marketplaces. The agency proposed updating its models with data from 2020 to 2022. In addition to updating the models, CMS is proposing phasing out special adjustments for hepatitis c drugs and adding new adjustments for pre exposure prophylaxis drugs to treat HIV. CMS is also seeking comment on how to reduce the risk of insurer insolvencies in the ACA marketplace.
In recent years, multiple plans have become insolvent, leaving enrollees without coverage and insurers without risk adjustment payments. Those proposed rules are open for comment until November 12th. Vice president Kamala Harris has proposed expanding Medicare coverage for home health care. Miss Harris explained the due details of her proposal on the daytime talk show, The View, Campaign AIDS told NPR. The benefit would cover the cost of in home health aids and other home services.
Medicare usually does not cover intermittent skilled nursing care at home or long term in home care. Miss Harris' campaign did not provide specific estimates for how much the proposal would cost. The proposal would be partially paid for by expanding Medicare drug price negotiations. The policy is designed to appeal to the, quote, sandwich generation or adults who care for both aging parents and children. More than 40% of Americans provide unpaid caregiving.
Donald Donald Trump's campaign said the former president's platform also includes a commitment to at home care. UPMC Health Plan is named Marybeth Jenkins president and CEO. That's effective January 1st. Miss Jenkins has also been named president of UPMC Insurance Services Division. She served in several roles at UPMC since 1998, most recently as EVP and COO
at UPMC Insurance Services Division. She's replacing current president and CEO Diane Holder, who is retiring at the end of the year after 4 years with the organization. And finally, CVS Health will lay off 416 employees at Aetna's headquarters in Hartford, Connecticut. In a more notice filed October 6th, the company said 93 employees work at the facility in Hartford. The other employees work remotely in several states but report to the Connecticut facility.
Most of those layoffs are effective December 7th. If you like the latest health insurance industry news delivered straight to your inbox every morning, subscribe to the Becker's Payer Issues e newsletter on our website at beckerspayor.com.