CMS Denies Humana's Appeal, Threatening 2026 Medicare Advantage Revenue

The Centers for Medicare and Medicaid Services (CMS) has denied Humana's appeal to enhance its Medicare Advantage star ratings, a decision that threatens the company's revenue for 2026. Following this denial on April 14, Humana, along with the advocacy group Americans for Beneficiary Choice, has initiated federal court proceedings against CMS. The controversy arises from a notable drop in Humana's star ratings, which the insurer attributes to abrupt changes in the rating methodology; under the latest ratings, the percentage of its enrollees in plans rated 4 stars or higher fell from 94% to just 25%. Humana contends that these changes have significantly harmed its ratings and questions CMS's adherence to its own guidelines.

Opens on Healthcare Finance News