Medicare Advantage Stars

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Medicare Advantage Stars

Last Updated: Thursday, April 30, 2026

Background

The Centers for Medicare and Medicaid Services (CMS) rates Medicare Advantage plans and prescription drug plans separately on a scale of one to five stars, with five representing the highest quality. The Star Rating for Medicare Advantage plans is an overall measure of the plan's quality, and is a cumulative indicator of: quality of care, access to care, beneficiary satisfaction, customer service, and responsiveness to member needs. The intent of the program is to tie quality of care to financial reimbursements, whereby rewarding high performing plans and forcing low performing plans to exit the market.

The quality scores for Medicare Advantage plans are based on over 50 distinct individual measures that are derived from four sources:

  • Healthcare Effectiveness Data and Information Set (HEDIS®)
  • Consumer Assessment of Healthcare Providers and Systems (CAHPS®) program
  • Centers for Medicare and Medicaid Services (CMS)
  • Health Outcomes Survey (HOS)

2026 Medicare Advantage Primary Care Incentive Measures

Dynamic Measures

Description and Gap Closure

Practice Materials

  • cpa/ sepa
  • neny

Blood Pressure Tracker

  • wpa/ nepa
  • de
  • wv
  • wny

Blood Pressure Tracker

Static Measures

Additional Resources

All Highmark Medicare Advantage members are eligible to participate in the Highmark Wellness Rewards Program and can earn rewards for completing certain preventive tests and screenings detailed on their Personalized Wellness Plan. Highmark will notify members by mail of any new reward opportunities throughout the year. These notifications are typically sent twice per year and via My Highmark. Reward opportunities and eligibility criteria are subject to change each year. Members should always refer to their Personalized Wellness Plan for the most up-to-date information.

How are rewards received?

To earn Highmark Wellness Rewards, the member must opt in to the Highmark Wellness Rewards Program, and the activity must be completed by the date identified on the member’s Personalized Wellness Plan. The Highmark Wellness Reward will be mailed directly to the member following the opt-in process and the processing of their claim. Members should allow up to eight weeks to receive their Highmark Wellness Reward.

To learn more about Highmark’s home visit programs, click here.

Everlywell At-Home Testing Kit Vendor

Highmark partners with at-home vendors to provide in-home testing kits by mail to select Medicare Advantage members. At home testing kits may include a FIT, KED, or A1c. These kits are mailed directly to members or can be requested by contacting Highmark Member Service. Each kit comes with simple instructions and equipment for collecting a sample, plus a postage-paid envelope for members to return the kit. Members will generally receive their test results within 1-2 weeks. The vendor will also send a copy of the member’s test result to their attributed PCP on file.

Below are examples of communications.

 

Outcomes

Highmark partners with a vendor, Outcomes, to enhance medication adherence services for members managing diabetes, hypertension and cholesterol. Outcomes leverages an omni-channel platform that allows pharmacists from different settings such as retail pharmacies, provider offices and Highmark to ensure members stay on track with their medication. This approach ensures members receive medication management support directly within their existing care journey.

 

Prime Therapeutics

Highmark partners with Prime Therapeutics to support members with Diabetes and Osteoporosis. For diabetic members, Prime ensures they receive appropriate statin medication, coordinating with providers and pharmacies to initiate therapy when necessary. For women with osteoporosis who experience a fracture, Prime's pharmacists collaborate with providers, members, and pharmacies to ensure timely and appropriate testing and treatment.