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As health plans look ahead to the new year, they face a dynamic environment full of shifting variables and challenges. Navigating stricter Medicare Advantage Star Ratings, evolving member expectations, and the shifting post-election political landscape requires more strategic foresight than ever before.
The newly released 2025 MA Star Ratings highlight a notable decline: only seven MA plans achieved the coveted 5-star rating, compared to 38 in 2024. Meanwhile, membership in 4+ star plans dropped to 62% from 79% the previous year, signaling reduced quality bonus payments (QBPs) for many plans. The average rating for top plans also dipped to 3.92—the lowest since 2015—impacting both financial performance and growth strategies. These shifts are partly due to stricter CMS cut points, which raised the bar for achieving high scores across key performance metrics, including member experience.
The outcome of the 2024 elections will also introduce policy shifts that could reshape healthcare priorities and regulations. Changes in Medicare Advantage funding, compliance mandates, and/or member benefits will require agility, flexibility, and preparedness. Plans must stay adaptable and anticipate how political decisions might influence operations, costs, and competitive positioning.
Meanwhile, the 2026 MA Proposed Rule aims to hold MA and Part D plans more accountable for delivering high quality coverage, with strong emphasis on health equity and whole person care. With so many moving pieces, MA plans must urgently recalibrate their onboarding and welcome strategies to elevate the member journey, close care gaps, and improve their Star scores.
6 best practices to unlock success in 2025
Start early, connect personally: Engaging members early in their healthcare journey is crucial for establishing a positive experience. A personalized, multi-channel approach—whether through email, phone, text, or apps—ensures communication aligns with member preferences, boosting engagement, confidence, and satisfaction from day one. Notably, 63% of MA members highlight early engagement as pivotal to their overall satisfaction. The challenge for health plans lies in managing the cyclical demand and providing just-in-time training to ensure new hires meet expectations, particularly during peak periods like AEP and HEDIS seasons. Industry trends indicate that leveraging Training-as-a-Solution can significantly boost agent speed-to-proficiency and customer satisfaction (CSAT), accelerating performance during these critical times.
Drive member engagement with data-powered strategies: Traditional methods—centered on complaints or CSAT scores—provide incomplete insights due to small samples and cyclical data, often delaying action and reducing relevance in dynamic member journeys. Creating detailed, segment-specific views of the member journey and identifying critical touchpoints throughout the year is critical to success. Layering data across these journeys highlights key factors influencing satisfaction based on member experiences. A centralized data source combining plan engagement, customer service, and social media interactions is equally essential. Linking these leading indicators with outcomes helps pinpoint the most impactful interventions for each member segment.
Gather real-time feedback: Incorporating real-time feedback during the onboarding process helps health plans better understand and cater to individual member needs. This information enables more accurate personalization, offering care that aligns with each member’s specific health conditions, preferences, and risk factors.
Empower members through education and self-service: Self-service options can help members navigate the plethora of legislative changes and plan choices every year and make more informed decisions, leading to better health outcomes and satisfaction. Supplementing customer education with AI generated videos and interactive walk throughs and providing tools that let members access their health information and manage care independently can significantly improve their experience.
Actively promote preventive care: Preventive care visits play a crucial role in improving both member health and key performance metrics such as HEDIS measures and MA Star Ratings. Early engagement strategies can significantly boost these visits, enhancing chronic disease management, risk adjustment reporting, and overall health outcomes. By focusing on preventive services, especially at the start of the enrollment season in January when members are most likely to utilize their benefits, health plans can lower long-term costs, improve member health, and strengthen their Star Ratings. This proactive approach also supports better quality scores, which directly influence CMS payments and a health plan’s competitive standing.
Personalize follow-up: Personalized follow-ups—such as welcome calls, surveys, and outreach for preventive care—are crucial to prevent disenrollment during open enrollment periods. This approach builds trust and positions health plans as reliable, long-term partners in members’ health journeys.
Elevating onboarding and member loyalty
According to McKinsey, fewer than half of members are fully satisfied with key aspects of their onboarding experience, such as condition-specific resources or selecting a primary care provider. This is particularly concerning for plans below 4 stars, as intensified competition and reduced rebates limit their ability to offer attractive benefits. Coupled with factors like increased buyer uncertainty, plan switching, and members not fully utilizing their benefits, MA plans face a perfect storm for member churn.
The key to effectively addressing these challenges lies in leveraging digitally enabled, cost-effective, and efficient engagement solutions. Tracking enrollment data—such as preferences, care gaps, and risk factors—enables personalized Welcome, Welcome Back, and HRA campaigns. Stratifying members by factors like “likelihood to disenroll” and using predictive analytics helps target interventions. For example, identifying members who’ve called multiple times or expressed dissatisfaction online allows for tailored responses. Additionally, reviewing supplemental benefits tied to retention can re-engage underutilizing members. Such a personalized, data-driven approach strengthens connections and boosts benefit adoption—ultimately improving member satisfaction and plan performance.
This article is written by Olga Golovin and was first published in Healthcare Business Today