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Medicare Advantage

KFF: Federal Spending on Medicare Advantage Quality Bonuses Rose to $13.4 Billion in 2026 While the Share of Enrollees in Qualifying Plans Hit Its Lowest Level Since 2018

Medicare's bonus program for high-rated private plans paid out more money than ever in 2026, but a smaller share of enrollees are in plans earning those ratings, according to a KFF analysis updated in August.

By the Goodsurance editorial teamSeptember 2, 2026

Federal spending on the Medicare Advantage quality bonus program reached at least $13.4 billion in 2026, up from $12.7 billion in 2025 and more than four times the roughly $3.0 billion paid in 2015, according to a KFF analysis updated in August 2026. At the same time, only 68 percent of Medicare Advantage enrollees are now in plans that qualify for quality bonuses, down from 75 percent in 2025 and the lowest share since 2018.

The quality bonus program, established by the Affordable Care Act, pays Medicare Advantage plans higher monthly rates from the government if they achieve a star rating of 4.0 or above on CMS's 5-star scale. Plans can use the additional funds to lower premiums, reduce cost sharing, or add supplemental benefits. CMS recalibrates the performance thresholds required to reach each star level each year, and KFF attributes the drop in the qualifying share to higher cut points in 2026.

Medicare paid 13.4 billion dollars in quality bonuses to private plans in 2026, but the share of MA enrollees in qualifying plans fell to its lowest level since 2018.

Among all insurers, UnitedHealth Group received the largest total dollar increase from quality bonuses in 2026, at approximately $3.9 billion above what base payments would have been without the program. Kaiser Foundation Health Plans received the largest increase per enrollee, at 577 dollars per person. The average across all individual Medicare Advantage plan enrollees was 438 dollars per person.

KFF separately noted that the court-ordered recalculation of 2027 star ratings, which moved up star scores for 47 plans, will add approximately $600 million in additional quality bonus payments in 2027. That 2027 adjustment is separate from the 2026 totals.

In plain words

The government paid about 13.4 billion dollars in bonuses to Medicare Advantage health plans in 2026 for getting good quality scores. That is four times more than it paid in 2015. But fewer people are now in plans that earn those bonuses. Only 68 out of every 100 Medicare Advantage members are in a qualifying plan, the lowest share since 2018. When a plan earns a bonus, it can use the extra money to lower premiums or add dental, vision, or other benefits. UnitedHealth Group got the largest total bonus, at about 3.9 billion dollars above its base payments.

Understand the basics first

Source: KFF
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