CMS has updated the star ratings for some UnitedHealthcare and Centene Medicare Advantage contracts following a successful court challenge from UnitedHealthcare.
On Dec. 2, the agency published updated star ratings for 12 UnitedHealthcare and seven Centene Medicare Advantage contracts. Two UnitedHealthcare contracts were upgraded from 4.5 to five stars.
On Nov. 22, a federal judge ruled that CMS must recalculate UnitedHealthcare's Medicare Advantage star ratings without including a disputed customer service phone call.
UnitedHealthcare filed a lawsuit in September, alleging CMS downgraded its star ratings based on one secret shopper phone call. UnitedHealthcare alleged the call never connected to its call center.
The downgraded ratings cost UnitedHealthcare $190 million in bonus payments, the company alleged.
Centene also challenged the inclusion of a secret shopper phone call in its star ratings in court. A ruling has not been issued in the case.
The agency upgraded seven of Centene's contracts on Dec. 2.
Becker's has reached out to UnitedHealthcare, Centene and CMS for comment and will update this article if more information becomes available.
Other insurers that have challenged CMS' star ratings did not receive boosted ratings. Humana also challenged its star ratings in court, alleging that CMS did not follow its own regulations in its methodology for calculating ratings.
Elevance Health and Blue Cross Blue Shield of Louisiana have challenged their star ratings on different grounds. In a lawsuit filed in a Texas federal court Oct. 31, Elevance Health alleged CMS' star ratings process was "fraught with statistical variance."
BCBS Louisiana alleged that CMS allows plans to submit data from both the surviving and consolidated contract when plans are combined for two years after the plans merge. The company alleged CMS did not use data from both contracts on some measures, resulting in lower ratings.
Medicare Advantage star ratings determine the bonus payments plans receive from CMS. The average star rating for 2025 is 3.92, down from 4.07 in 2024. The agency said it did not make major methodological changes between 2024 and 2025, but cut points were tougher in 2025 than in 2024, meaning plans had to perform better to achieve higher ratings.