Research Alert: May 13, 2026

Trends in Medicare Advantage Quality for Nonmetropolitan Enrollees, 2019-2023

This brief analyzes Medicare Advantage (MA) star rating data for 2019 to 2023 for all (non-special needs) contracts and describes patterns across geography, by region, and by plan type. High ratings generate bonus payments, within parameters of benchmarks and payment caps set by the Patient Protection and Affordable Care Act, 2010.

Key Findings:

• Average star ratings for MA plans selected by nonmetropolitan (i.e., both micropolitan and noncore) beneficiaries increased from about 3.90 stars in 2019 to 4.15 stars in 2023. Meanwhile, metropolitan beneficiaries' plans increased from 4.05 stars to a peak of 4.32 stars in 2022, declining to 4.15 stars in 2023.
• Star rating component scores for "staying healthy" and "managing chronic conditions" are consistently higher in metropolitan areas. Conversely, "member experience with the health plan" is reported to be lower for metropolitan beneficiaries than nonmetropolitan beneficiaries. The main source of improvement in nonmetropolitan areas is the change in the "health plan customer service" domain.
• In counties where MA plans cannot earn any quality incentives due to statutory caps in total payment, star ratings tend to be about 0.1 star lower than when quality bonus rates are not all capped based on pre-Affordable Care Act (ACA) total Medicare expenditures.

Additional Resources of Interest:

• More FORHP-funded research on Medicare Advantage (MA)
• More information about the RUPRI Center for Rural Health Policy Analysis