Medicare insurance agents near me are fielding questions about star ratings as Centene sues CMS. Here is what the ratings mean for your 2027 plan choice. On Oct. 22, Centene filed suit in federal court in Georgia, challenging 17 measures used to calculate 2027 Medicare Advantage star ratings. The lawsuit arrives during the annual enrollment period, which runs Oct. 15 through Dec. 7. Healthcare Dive, reporting by Rebecca Pifer Parduhn says Centene argues that CMS used measures without proper notice-and-comment or beyond its statutory authority. The claims are allegations, and the case remains pending.
What star ratings actually are and why insurers sue over them
Medicare Advantage star ratings summarize performance on measures related to health care and prescription drug services. CMS assigns ratings from one to five stars using measures such as preventive care, member experience, customer service, and drug-plan performance. Ratings appear in Medicare’s Plan Finder alongside plan information.
The 2027 ratings are based on contract performance and will affect quality bonus payments for 2028. According to CMS’s 2027 Star Ratings fact sheet, 508 Medicare Advantage contracts that include prescription drug coverage received an overall rating. Of those, 188 contracts, about 37%, earned four or more stars. About 71% of enrollees in those contracts were enrolled in a contract with four or more stars.
The rating system is a source of legal disputes because CMS’s measures and calculations can affect both a plan’s public rating and its payment eligibility. Centene challenges 17 measures. Healthcare Dive reports that Alignment Healthcare has challenged 10 measures and Healthfirst five. The cases follow litigation involving Clover Health, in which a court ruled 20 measures unlawful this spring. CMS still used some of those measures in calculating ratings for other insurers.
Centene argues that CMS’s approach to the disputed measures lacks a meaningful legal distinction from the measures excluded for Clover. CMS has said it does not comment on pending litigation. No final ruling on Centene’s claims has been reported.
The money behind the fight: how bonuses pay for the benefits you compare
A four-star rating can have financial consequences. Under the Medicare Advantage Quality Bonus Program, qualifying plans receive benchmark increases. The resulting funding may support extra benefits, lower cost sharing, lower Part B premiums, or other plan expenses. Plans are not required to use the additional funding for any particular benefit.
The dollars involved are substantial. KFF’s analysis estimates that federal spending on the program will reach at least $13.4 billion in 2026. KFF reports that 68% of Medicare Advantage enrollees, nearly 24 million people, were in bonus-status plans that year, down from 75% in 2025. KFF estimates that average bonus payments per enrollee for individual plans were $381.
For consumers, that financial link helps explain why a lawsuit about rating measures may matter beyond a company’s score. Bonus funding can influence the resources insurers have when designing benefits such as dental or vision coverage and reduced copays. It does not guarantee that a specific benefit will be included or remain available. The dispute is therefore also about how ratings may affect plan funding and benefit design in 2028.
What the lawsuit means for the 2027 and 2028 plan years
The ratings currently displayed for 2027 are relevant to people choosing coverage for 2027, but the ratings will affect 2028 quality bonus payments. Centene says its share of members in contracts rated four stars or higher declined from 16% for 2026 to 12% for 2027. The company estimates that the change could reduce quality bonus payments and rebates by $448 million in 2028.
Centene also says two of its contracts fell below three stars and will receive a “low performance indicator” on Medicare plan-finding tools. That indicator is a visible warning on a listing. It should be considered alongside the plan’s actual benefits, costs, and provider access, rather than as a substitute for comparing those details.
A court-ordered recalculation could change a contract’s rating or the payments tied to it. If a rating changes, it could affect the plan’s funding and design in a later year. That does not establish that 2027 benefits will change during the year. Plan benefits and costs are set for each plan year, so coverage selected for 2027 should be reviewed again before choosing a plan for 2028.
How to read star ratings the right way
A star rating is a useful starting point, not a complete measure of whether a plan fits an individual’s needs. Ratings are reported at the contract level, not separately for every plan under that contract. As KFF notes, a contract may include multiple plans with different benefits, costs, networks, service areas, and enrollment groups. A four-star contract label therefore may not describe every detail of each plan under it.
Use the rating as an initial screen. A rating of 3.5 stars or higher can be a practical comparison threshold, with four or more stars indicating eligibility for bonus status in the program. These ratings do not establish that a plan’s doctors, prescriptions, or costs fit a particular person.
A short plan-comparison checklist:
- Screen by rating. Compare ratings in Medicare Plan Finder. Note any low-performance indicator.
- Verify doctors and facilities. Check that each preferred doctor, specialist, hospital, and pharmacy is in the specific plan’s network. Confirm directly with providers and the plan.
- Check prescriptions. Confirm each medication is on the plan’s formulary. Review tiers, restrictions, preferred pharmacies, and estimated costs.
- Compare costs for the specific plan. Review premiums, deductibles, copays, coinsurance, and the plan’s out-of-pocket maximum in its current Summary of Benefits and Coverage. Do not rely on the contract rating or another plan’s cost figures.
- Review the plan year. Confirm that displayed benefits and costs apply to 2027. Recheck coverage during a future enrollment period.
When to bring in a licensed Medicare insurance agent
A licensed Medicare insurance agent can help compare plan documents, networks, formularies, and the possible relevance of a pending rating lawsuit to a specific contract. The agent should identify the plan and contract being discussed and distinguish current, confirmed plan details from possible future changes.
Before sharing Medicare numbers or other personal information, check the agent’s insurance license through the relevant state insurance department. The National Producer Number (NPN) can help identify a producer, but it does not replace state license verification. A directory listing is a research starting point, not proof of current licensure. VerifiedAgent’s Georgia agent directory can be used to locate profiles; license status should be independently confirmed through the state regulator.
Frequently asked questions
Does a four-star rating mean a Medicare Advantage plan is the best choice?
No. A four-star rating is a contract-level quality indicator and can affect bonus eligibility. It does not confirm that a specific plan includes a person’s doctors, medications, preferred pharmacy, or suitable cost-sharing.
Will Centene’s lawsuit change my 2027 benefits?
No change to a particular person’s benefits follows automatically from filing the lawsuit. The case is pending. A later court decision or recalculation could affect ratings and payments, but plan benefits for 2027 should be checked in the plan’s current materials.
Why does a star-rating lawsuit matter to plan benefits?
Ratings can affect bonus payments to plans. Those payments may contribute to benefit design, including supplemental benefits or reduced cost sharing. The relationship is not a guarantee that a particular benefit will be offered.
What does the low-performance indicator mean?
It is a visible indicator on Medicare plan-finding tools for certain contracts with consistently low ratings. Centene says two of its contracts below three stars are set to receive one. Review the specific plan’s current information and compare its coverage, costs, and network.
Where can the 2027 ratings be compared?
The ratings appear in Medicare’s Plan Finder, alongside plan benefits and costs. The displayed rating should be checked against the details for the individual plan being considered.
The bottom line
Centene’s lawsuit challenges measures used in the 2027 Medicare Advantage star ratings. Those ratings are visible during the current enrollment period and affect quality bonus payments for 2028. Ratings can help screen options, but they do not replace comparing each plan’s network, prescription coverage, benefits, and cost-sharing. The case remains pending, and future ratings or payment calculations may change. Plan details and agent licensing should be independently confirmed before enrollment or disclosure of Medicare information.