📝 Episode Description

Medicare Advantage contracts earning 4 or more Stars fell from 261 to 207 for 2026, while enrollment in bonus-qualifying plans dropped to 68 percent. Because CMS resets rating cut points annually, a plan can perform similarly and still receive a lower score.

That matters because 4-Star bonuses help support dental, vision, givebacks, and low-premium benefits. Total bonus spending rose to $13.4 billion but is now concentrated across fewer contracts.

The Veteran and The Closer explain the client impact, recent legal challenges involving Clover Health and Elevance, and how agents can review affected business before open enrollment.

🔑 Key Topics Covered

• Why Star ratings can fall
• Annual CMS cut-point changes
• Bonus dollars and plan benefits
• Clover and Elevance legal challenges

🎯 What This Means for Agents

• Lower ratings do not always mean worse performance
• Bonus changes may affect future benefits
• Clients need clear, compliant explanations
• Early outreach can protect retention

🔗 Sources

Quality Bonus Program funding
Medicare Will Spend More Than $13 Billion on the MA Quality Bonus Program in 2026 (KFF, via Medicare Report, July 1, 2026)

Star ratings shift and strategy
Medicare Advantage Star Ratings Are Changing: Is Your Strategy Ready? (mPulse, July 8, 2026)

Elevance lawsuit over star ratings
Elevance Sues CMS Over Star Ratings (MedCity News, Marissa Plescia, July 7, 2026)

📌 GO-DO: Audit Ten Clients

Pull your Medicare Advantage book and flag clients whose plan or contract changed Star ratings for 2026. Schedule ten-minute annual reviews with the first ten clients, using the episode script. Use PSM’s outreach materials and submit your message to Compliance before sending.

Tags: Medicare, Medicare Advantage, star ratings, insurance agents, PSM Brokerage, CMS, enrollment, compliance, quality bonus, retention

Infographic: https://www.psmbrokerage.com/hubfs/The%20Insurance%20Producers%20Guild/IPG_EP18_Infographic.png

Slides: https://www.psmbrokerage.com/hubfs/The%20Insurance%20Producers%20Guild/IPG_EP18_Slides.pdf

The Insurance Producers Guild Podcast delivers intelligence for insurance agents looking to stay ahead of industry trends.

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