Inovalon’s Clients Lead the Nation in 2026 CMS Star Ratings

Even as CMS Star Ratings begin to stabilize, many health plans still feel in the dark — but some plans aren’t flying blind.

CMS recently released its 2026 Star Ratings for Medicare Advantage (MA) and Prescription Drug Plans (PD), and while the market saw little overall movement, health plans using Inovalon’s Converged Quality^TM solution stood out once again.

A closer look at 2026 CMS Star Rating results 

The industry average rating inched up slightly from 3.95 to 3.98, reflecting a relatively stable year overall after several volatile cycles. While the share of MA contracts with 4+ stars dipped slightly (from 40.9% to 40.1%), the percentage of members enrolled in those higher-rated plans actually grew — from 63.8% to 64.3%. Much of this leveling off stems from plans adapting to CMS’s updated methodology, including the Tukey method introduced last year to limit the impact of outliers. 

An analysis of CMS data revealed the following trends:  

• 5-star rated plans were right sized compared to 2025, which had an unusually low number of 5-star plans. The number of 5-star plans doubled from 2025 to 2026, but is still lower than the three years prior.  
• There is a clustering of plans in the 3.5 star range and the percentages of those plans stayed static compared to 2025, most likely due to the Tukey implementation which accounts for outliers. 
• Exterior forces, including policy changes and increased cost, led to the consolidation and closure of H-contracts (516 rated plans in the 2026 rating year, down from 521 in 2025, 545 in 2024).

Health plans leveraging Converged Quality with Managed Services achieved 11% higher ratings than those using other solutions, and across all Converged Quality customers, Inovalon-powered plans averaged 4.08 Stars, meeting the eligibility threshold for Quality Bonus Payments and outperforming the national average. Of the 18 health plans that earned the coveted 5-star rating, eight — nearly half — use Inovalon’s data-driven software. 

In total, 60% of all Medicare covered livers (20.9 million) and more than 70% of MA enrollees in 4+ star plans (15.6 million of 22.3 million lives) were processed using Inovalon’s software, fueling predictive cut point forecasting, reporting on quality improvement initiatives, Medicare benchmarking, and more.¹

The timely insights into measure performance throughout the year, analytically driven intervention planning and prioritization, and patient-specific intervention outreach provided by Inovalon solutions all helped health plans address quality measure gaps, contributing to their above-average performance.  

Seeing through the shifts 

CMS methodology continues to evolve, keeping plans on their toes. Notable changes in the 2026 CMS Star Ratings methodology included:  

• The respecified Controlling Blood Pressure (CBP) measure is no longer considered new, and the guardrails are now applied. 
• A decrease in weighting for patient experience, complaints, and access measures (from 4 to 2). 

Inovalon remains at the forefront of helping customers understand these shifts — providing early insight into how methodology changes and cut points will affect performance. In fact, despite the shifting landscape, Inovalon’s cut point forecasting was 97% aligned with CMS’ official results for 2026, providing critical visibility to health plans and helping them stay ahead of the curve.

Measure-level cut points: small shifts, big impacts 

In addition to the Tukey method, there have been guardrails in place since the 2023 Star Ratings that apply to all non-CAHPS and non-improvement measures that have been in the Medicare Part C (MA) and Part D star ratings program for more than three years that limit cut point movement — up or down — to no more than five percent. Even with guardrails in place, some measures experienced meaningful cut point movement.  

Understanding these shifts is key to staying proactive: 

• Follow-Up After Emergency Department Visits for People with Multiple High-Risk Chronic Conditions (FMC) had one of the largest increases in cut points, raising the bar significantly.  
• Care for Older Adults – Medication Review and Diabetes Care – Eye Exam also saw notable increases in cut points, though less dramatic than FMC. 
• Colorectal Cancer Screening (COL) and Annual Flu Vaccine (FSO) saw decreases in cut points compared to last year. The COL drop likely reflects CMS’s adjustment to the measure’s shift from a traditional HEDIS® hybrid measure to an ECDS format, while the FSO change could relate to ongoing post-pandemic vaccine hesitancy. 

For 2027 and beyond, plans can expect more limited cut point movement for established measures, even when performance changes would typically drive bigger shifts. Having forecasting and analytics in place will be key to identifying where to focus quality improvement efforts. 

What’s on the horizon for 2027 

Change is already in motion for next year.  

CMS is introducing new measures:  

• Care for Older Adults – Functional Status Assessment 
• Concurrent Use of Opioids & Benzodiazepines 
• Poly Pharmacy Use of Mult-Anticholinergics  
• MTM Program Completion Rate for CMR 

And retiring others:  

• Care for Older Adults – Pain Assessment 
• Medication Reconciliation Post-Discharge 
• MTM Program Completion Rate for CMR  

The new Excellent Health Outcomes for All (EHO4all) reward will replace the Health Equity Index, emphasizing outcomes for socially at-risk members. EHO4all utilizes data from the 2024-2025 measurement period onwards and will impact 2027 CMS Star Ratings and Rewards.  

There has been a significant growth in the number of MA Dual-Eligible Special Needs Plans (D-SNPs), with a notable increase in enrollment and market share. This growth is driven by the integration of Medicare and Medicaid, which is a priority for CMS. D-SNPs populations will have a big impact with the introduction of the new EHO4all factor as it specifically looks at socially at-risk members, including low-income subsidies. 

For plans that want to keep their finger on the pulse, access to timely data and predictive forecasting will be key to staying proactive, not reactive. 

Don’t fly blind on CMS Stars 

Inovalon enables quality measurement for more than 80 health plans, processing over 205 million lives each year for state and federal quality measurement, representing over 60% of the entire U.S. population.² 

With Converged Quality, you don’t have to wait for October to see how you performed. The solution gives you real-time visibility, forecasting accuracy, and the insights you need to stay ahead year-round — so there are no surprises when CMS releases its ratings. 

Here’s how Converged Quality helps you stay in the know and keep your finger on the pulse of performance: 

• Forecasting & Benchmarking: Predict your CMS Star Rating with 97% accuracy and see how each measure impacts your overall score. With Inovalon’s forecasted cut points now built directly into Inovalon’s benchmarking tool, you can assess your current performance, compare against national benchmarks, and utilize predictive analytics to prioritize high impact measures.  
• Quality Analytics: Converged Quality’s powerful analytics and drill-down transparency let you explore measure rates, identify gaps, and uncover the “why” behind your performance — empowering you to move from reactive to proactive. 
• Intervention Planning: Inovalon provides a single touchpoint for coordinated, data-driven intervention planning. Engage members earlier, focus your resources where they’ll have the most impact, and close care gaps before it’s too late. 
• EHO4all Insight: Get an early view into your EHO4all performance with contract- and measure-level detail. Estimate potential bonus payments and optimize improvement strategies for socially at-risk members to strengthen your CMS Star Rating in 2027.

With Converged Quality, you gain the clarity and confidence to navigate CMS Stars year-round — staying informed, proactive, and ready for what’s next. 

Stay in the know. Stay ahead.
Request a demo and see how Inovalon helps plans achieve quality excellence

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1. Inovalon calculation based on HEDIS® MY2024 data. September 2025.

2. Inovalon internal reporting, July 2025. Based on Measure Year 2024 population counts and U.S. Census Data as of December 2024, https://www.census.gov/data/tables/time-series/demo/popest/2020s-national-total.html

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).