How Medicare Advantage Plans Pay Practices for Star Ratings

Updated October 2026. Written by Matteo Grassi, clinical psychologist and cofounder of HANA Health.

A Medicare Advantage Star incentive is a bonus a health plan pays a practice when the members attributed to it score well on CMS Star measures. The plan sets the dollar amount, not CMS. Aetna's 2026 program, for example, pays a group up to $14.40 per member per month, scaled to its Star composite score.

From the clinical side, what stands out in these payment tables is how little they pay for the visit itself and how much they pay for what happens between visits.

Key facts

• Enrollment: 35.2 million people, or 55% of eligible Medicare beneficiaries, were in Medicare Advantage in 2026, per KFF's 2026 enrollment update.
• Bonus spending: federal spending on the Star quality bonus program is at least $13.4 billion in 2026, up from $12.7 billion in 2025, and 68% of enrollees are in qualifying plans, per KFF.
• How plans qualify: plans rated 4 stars or higher get a higher benchmark, usually five percentage points higher, per KFF.
• 2027 Star Ratings: about 71% of Medicare Advantage drug plan enrollees are in contracts with 4 or more stars, and these ratings affect 2028 bonus payments, per the CMS fact sheet of October 8, 2026.
• Weights: blood pressure control, blood sugar control, plan readmissions and the three medication adherence measures each carry a weight of 3 in 2027, while Transitions of Care and ED follow up carry 1, per CMS.
• Aetna 2026: the quality program pays $1.00 to $12.00 per member per month by Star composite, or up to $14.40 with 50% annual wellness visit completion, plus $1.00 more for strong triple weighted measures, per the Aetna handbook.
• UnitedHealthcare 2026: its primary care program pays $150 per Key Care Opportunity closure on blood pressure control and each adherence measure, per UnitedHealthcare.

How do Medicare Advantage plans pay practices for Star performance?

They pay through the contract, not through Medicare. CMS rates the plan, the plan earns a bonus through a higher benchmark, and the practice earns money only if its agreement with that plan says so.

That last step isn't automatic. KFF notes plans may, but aren't required to, use the extra payment for supplemental benefits, lower premiums or other purposes. There is no separate bonus check to pass along. The higher benchmark shows up inside the plan's bid and rebate.

In practice, the contracts we can read in public follow two shapes. One pays a monthly amount per attributed member, scaled to a Star composite score. The other pays a flat amount each time a specific care gap closes. Both depend on which members the plan attributes to your group, so your panel report matters as much as your clinical work.

Timing runs a year behind. Aetna's handbook says it reconciles on or about October 31 after the contract year ends and pays in December. UnitedHealthcare's 2026 annual bonus has a May 31, 2027 payment date. A gap you close in March gets paid the following spring or winter.

Which Star measures carry the most weight for a practice?

The measures that move a plan's rating most are the ones with a weight of 3. CMS says a measure weighted 3 counts three times as much as a measure weighted 1 in the summary and overall ratings.

For the 2027 Star Ratings, the weight 3 group a practice can influence includes:

• Controlling Blood Pressure: share of adults with hypertension whose latest reading is controlled. Weight 3.
• Diabetes blood sugar control: share of adults with diabetes whose glycemic status is in range. Weight 3.
• Plan all cause readmissions: weight 3.
• Medication adherence for diabetes, hypertension (RAS antagonists) and cholesterol (statins): three separate Part D measures, each weight 3.

Measures with a weight of 1 still show up in payer contracts. These include Transitions of Care, follow up after an ED visit for people with multiple chronic conditions, the diabetes eye exam, kidney health evaluation and statin therapy for cardiovascular disease.

Two more things to know. CMS also moved Improving or Maintaining Physical Health and Mental Health to a weight of 3 in 2027, but those come from member surveys, so a practice can't close them like a gap. And CMS retired Medication Reconciliation Post-Discharge from the Star Ratings, so check whether a contract still pays on it. For a deeper look at the adherence group, see our explainer on the Star Ratings adherence measures.

What does a Star composite payment look like in dollars?

It looks like a table lookup multiplied by member months. The clearest public example is the worked reconciliation in Aetna's 2026 handbook, which we've followed line by line below.

1. Composite score: the example's weighted star values add up to 86 and the weights add up to 22. Then 86 ÷ 22 = 3.9.
2. Annual wellness visit factor: the group completed 58% of annual wellness visits, above the 50% threshold, so the 3.9 row pays $4.80 instead of $4.00. That's the 1.20x factor.
3. Member months: the example uses 4,800. That equals 400 members for 12 months (our arithmetic: 4,800 ÷ 12).
4. Domain 1 payment: $4.80 × 4,800 = $23,040.
5. Domain 2 payment: all triple weighted measures reached 4 stars or higher, so $1.00 × 4,800 = $4,800.
6. Total: $23,040 + $4,800 = $27,840, or $5.80 per member per month.

Now look at the table's shape. At a 3.9 composite with the wellness visit factor, the payment is $4.80. At 4.0 it's $8.40. For the same 4,800 member months, that's $40,320 against $23,040, a difference of $17,280 for one tenth of a Star point (our arithmetic: $8.40 × 4,800 = $40,320).

That cliff is why quality leads watch the composite so closely near the 4.0 line. It's also a reason to treat any single year's number with caution, since CMS recalculates cut points every year.

How do per gap closure bonuses work?

They pay a fixed amount each time a listed measure closes for an attributed member. UnitedHealthcare's 2026 Medicare Advantage Primary Care Physician Incentive program is a public example.

Its Key Care Opportunity amounts include:

• Controlling High Blood Pressure: $150 per closure.
• Glycemic status assessment for patients with diabetes: $150 per closure.
• Medication adherence for diabetes, hypertension and cholesterol: $150 per closure, each.
• Statin Use in Persons with Diabetes: $20 standard, $250 as a Key Care Opportunity.
• Concurrent use of opioids and benzodiazepines, and anticholinergic polypharmacy: $500 per closure, each.
• Key Care Annual Care Visit: $100.

A Complete Care Bonus adds $100 for a member with at least one Key Care Opportunity when the practice addresses 100% of the eligible measures listed for that member. Compensation is limited to one compliant closure per member per year, with exceptions for two post visit measures.

Blood pressure and adherence measures are paid at year end based on final compliance. So a patient with controlled pressure in March can still lose you the payment if the last reading of the year is high. We cover that in our guide to closing blood pressure control gaps between visits.

What do these programs not tell you?

They don't tell you what your own contract pays, and they don't prove the incentives are well designed. Treat these two programs as examples of structure, not as a market rate.

Here are the honest limits. Both documents describe 2026 terms, and both reserve the right to change measures if CMS changes them. Payers don't share one design, so another plan can pay a flat fee per member, a share of savings or nothing on Stars at all. Attribution also varies by plan, and you only get paid on members the plan assigns to you.

Even the size of the pool is estimated differently. KFF puts 2026 bonus spending at least $13.4 billion with 68% of enrollees in qualifying plans. MedPAC's March 2026 report estimates about $16 billion and 64%. And MedPAC says it's concerned the Star system isn't an adequate measure of the quality of care enrollees can expect.

So read your own agreement. Find the measure list, the payment table, the attribution rule, the payment date and the clause that says what happens if CMS changes a measure.

What this means for your practice

Start with the contract, then work backward to the calendar.

• List what you're paid on. For each Medicare Advantage plan, write down the measures, the dollars and the payment dates in one sheet.
• Rank by weight and dollars. A weight 3 measure with a $150 closure and a Star composite effect deserves attention before a weight 1 measure with a $10 closure.
• Find your cliff. If a plan pays by composite, find the nearest threshold, such as the 3.9 to 4.0 jump above, and count how many closures it would take.
• Plan for the last reading of the year. Blood pressure and adherence results are decided late. Schedule outreach for the fall, not only the spring.
• Reach people between visits. Refill gaps and uncontrolled readings are mostly follow up problems, not appointment problems.

HANA Remote is the phone based engagement layer HANA offers practices for between visit outreach. If you're also in an accountable care organization, our guide to ACO quality measures for practices shows how these same measures show up in shared savings, and our note on what the LEAD model means for practices covers the 2027 change.

Frequently asked questions

Do Medicare Advantage plans have to share Star bonus money with practices?

No. KFF says plans may, but aren't required to, use the higher payment for benefits or premiums. A practice is paid only what its contract with the plan promises.

When do practices get paid on Star measures?

It depends on the contract. Aetna's 2026 handbook reconciles about October 31 after the contract year and pays in December. UnitedHealthcare's 2026 annual bonus has a May 31, 2027 payment date. Quarterly items pay sooner.

Does CMS give each practice its own Star Rating?

No. CMS rates Medicare Advantage contracts, not practices. You see your own results in the payer's attribution and care gap reports, such as UnitedHealthcare's Patient Care Opportunity Report.

Can one practice have Star incentives from several plans?

Yes, if it contracts with several plans, though each program is a separate agreement. Measures, dollars and payment dates can differ, so most practices track them in one place.

What is a Complete Care Bonus?

In UnitedHealthcare's 2026 program, it's $100 for a member with at least one Key Care Opportunity when the practice addresses all eligible measures listed for that member.

Sources

1. KFF, "Medicare Advantage in 2026: Enrollment Update and Key Trends," 2026. kff.org
2. KFF, "Medicare Will Spend More Than $13 Billion on the Medicare Advantage Quality Bonus Program in 2026," 2026. kff.org
3. CMS, "2027 Medicare Advantage and Part D Star Ratings" fact sheet, October 8, 2026. cms.gov
4. CMS, "2027 Star Ratings Measures and Weights," 2026. cms.gov
5. Aetna, "2026 Medicare Advantage Quality Incentive Program" handbook, 2026. aetna.com
6. UnitedHealthcare, "Medicare Advantage Primary Care Physician Incentive program," 2026. uhcprovider.com
7. MedPAC, "The Medicare Advantage program: Status report," March 2026 Report to the Congress. medpac.gov

This article is educational and isn't billing, coding, clinical or legal advice. Check current CMS guidance and your MAC before you bill.

If you want to talk through between visit outreach for your Medicare Advantage panel, book a discovery call.