Humana plans to achieve 4 stars in its Medicare Advantage star rating in 2028, according to information released during its Investor Conference on Monday.
Humana told investors that it doesn't foresee achieving the total points needed to achieve a 4-star rating until bonus year 2028, according to Seeking Alpha.
Humana missed achieving 4 stars for 2026 by a few points in key contracts, it told investors. But these contracts represented about 80% of MA membership.
To achieve its goal, Humana plans to set internal targets that are above its forecasted 4-star threshold, make earlier investments in star programs, enact initiatives to achieve aggressive targets, align associate incentives to enhance accountability and increase preventative care visits.
Preventable care is critical for star ratings, Humana said. In 2025, the goal is to increase preventative visits by about 20%.
Also, Humana said it will use enhanced data and analytics to rigorously track progress and adjust where needed.
WHY THIS MATTERS
Star rating bonuses represent billions of dollars for MA businesses. The Centers for Medicare and Medicaid Services awards these bonuses to plans that achieve 4 or 5 stars in the annual Medicare Advantage and Part D Star Ratings released each October.
Only about 25% of Humana's members were enrolled in Medicare Advantage plans rated 4 stars or higher for 2025, down from 94% in 2024. Humana cited a drop in ratings for one plan, which fell from 4.5 to 3.5 stars. The plan contained about 45% of the insurer's Medicare Advantage membership.
The insurer blamed cut points, the upper and lower thresholds for each measure used to determine a plan's overall score, from 1 to 5 stars.
In October 2024, Humana sued CMS in a Texas federal court after it lost its 4-star MA plans rating.
During the Investor Conference, CEO Jim Rechtin said that Humana is planning its business around losing that lawsuit in Texas, according to Seeking Alpha.
Only seven plans received 5 stars for Parts C and D performance in the 2025 Medicare Advantage and Part D Star Ratings. This compares with 38 contracts that received 5 stars in 2024.
THE LARGER TREND
Humana is second only to UnitedHealthcare in terms of market share for Medicare Advantage plans.
On Monday, Humana told investors that its MA business has a projected long-term margin of 3%.
Its business is expected to grow as the 65-plus population is projected to climb by 13% by 2030. Humana said it projects a six-point increase in the MA-eligible population between 2024 and 2030, which means an estimated growth of 9 million members by 2030.
MA enrollment grew significantly from 2015 to 2019 before being disrupted by COVID-19 in 2020. A reset happened in 2024 due to regulatory changes, Humana said.
Email the writer: SMorse@himss.org