Star ratings: fifteen billion dollars a year, on measures Congress's advisers call flawed
MedPAC told Congress in 2024 that Medicare Advantage quality measurement is flawed and not a reliable basis for judging plans, yet the bonus programme it feeds adds about fifteen billion dollars a year to plan payments.
We have not finished checking this source. No judgement either way. how we score evidence
Caveat on this rating: MedPAC's estimates are contested by the plans and their trade association; the commission's methods are published and its critics' are not summarised here.
Significant findings
If you are in a Medicare Advantage plan, your screens and diagnoses also feed a second system: the star ratings. The Medicare Payment Advisory Commission, which advises Congress, described it in March 2024. "Medicare currently collects close to 100 MA quality measures, 40 of which are used to determine a star rating from 1 to 5"; "since 2012 the star rating system has been the basis for the QBP, which increases benchmarks for MA contracts rated 4 stars or higher."
Its judgement: "the Commission has determined that the current system for MA quality reporting and measurement is flawed and does not provide a reliable basis for evaluating quality across MA plans. Nonetheless, these measures are the basis for the MA quality bonus program (QBP), which uses trust fund and taxpayer dollars to increase MA payments by about $15 billion annually." "Forty-two percent of all MA contracts are in bonus status for 2024" and "Roughly three-quarters of MA enrollees are enrolled in contracts with a 4-star rating or higher."
The wider finding: Medicare "spends an estimated 22 percent more for MA enrollees than it would spend if those beneficiaries were enrolled in FFS Medicare, a difference that translates into a projected $83 billion in 2024", and "MA plans' diagnostic coding practices increase payments and distort the goal of plans competing to improve quality and reduce health care costs."
Worth asking
This money is the plan's, not your doctor's. It is on this page because the forms you fill in and the diagnoses recorded at your visits are inputs to it. Which measures actually feed the stars is in the next row, and the answer for depression is not what most people assume.
Source
Report to the Congress: Medicare Payment Policy, March 2024, Chapter 12: The Medicare Advantage program: status report — Medicare Payment Advisory Commission (MedPAC) (2024)
How this was scored
- Study design
- not recorded
- Funding
- not recorded
- Published in
- not recorded
- Sample size
- not recorded
- Preregistered
- not recorded
- Conflicts disclosed
- not recorded
- Independent of proponent
- not recorded
- Retracted
- No
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Published September 17, 2026.
Questions
How strong is the evidence behind this?
veisund rates this source "not yet assessed". We have not finished checking this source. No judgement either way. One caveat travels with that badge: MedPAC's estimates are contested by the plans and their trade association; the commission's methods are published and its critics' are not summarised here. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Report to the Congress: Medicare Payment Policy, March 2024, Chapter 12: The Medicare Advantage program: status report — Medicare Payment Advisory Commission (MedPAC) (2024). The full source is linked on this page so you can read it yourself.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.