Using AI to Improve Star Ratings in 2026

Last Updated: January 2026

With nearly 20% of the adult U.S. population opting into a Medicare plan in 2025, and those numbers are anticipated to grow in the next decade, there is a need in the market for coverage options. Medicare plans that are working to proactively stay ahead of the competition by focusing on how to retain and attract customers will see powerful benefits reflected in their Star Rating.

Do You Have a Clear Path to Improve Star Ratings?

CMS shared that the average plan ratings have continued to dip for the fourth straight year– from 4.37 in 2022 to 3.92 in 2025. We often hear from Medicare Advantage leaders, “We have initiatives to drive towards 4 Stars next year,” yet only 40%of Medicare Advantage plans offered in 2025 earned four stars or higher.

Reaching a 4-Star threshold grants Medicare Advantage plans more benefits and reflects strong consumer satisfaction. However, it’s often a challenge for leaders to understand the reasons and drivers behind lower-than-expected Star performance in key categories. 

While the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey typically affect 30%-35% of a plan’s total Star Ratings score, the results may lack context and only provide an annual read-out – two limiting factors in building a strategic plan to pivot and adjust in order to improve ratings. Medicare Advantage leaders need a clear path to aggregate, review, and act on member experience data.

3 Ways AI is Being Used to Improve Star Ratings

Artificial intelligence (AI) is unlocking new ways to analyze data and aggregate insights, through member interactions which hold valuable data insights that can lead to improved quality and positive revenue impact. Medicare-specific AI models uncover emerging trends and identify the biggest issues facing members, the brand, and employees.

Leveraging AI innovations to listen directly to and strategically act on member feedback can improve Star Ratings by:

1. Leverage feedback directly from members
   • With millions of member interactions per year, it is impossible to understand and properly act on member friction trends unless it is done with high accuracy and at scale. AI can analyze conversations and other unstructured data sources so member insights can be directly applied to business growth strategies. With these insights, Medicate leaders can:
     • Understand what members value and dislike about the plan(s)
     • Identify current friction points impacting enrollment and retention issues
     • Find solutions for repeat callers before they decrease NPS and CSAT scores, sentiment, and increase costs
2. Improving results with strategic prioritization
   • Open enrollment is not the time to understand the member journey and learn there are friction points along the way. The marketplace is competitive, with different options and coverage plans among various payers. AI offers a competitive advantage strategically directing resources to best enhance and support the member experience, so plans are prepared well ahead of this year’s open enrollment period.
     • Aggregate reports that highlight trends and improvement over time 
     • Pinpoint recurring issues, complaints, and barriers 
     • Quantify how your process is navigated with context 
3. Being proactive
   • This year’s Star Ratings are already reported. Are you where you want to be? Do you have a plan to maintain your current status? If the answer is no, AI can be a proactive measure to cut through the noise to understand what is valued most about the current plan and be invaluable in rising above your competitors. If yes, AI can help improve efficiencies in executing the plan and validating the team’s strategic direction. Further steps include:
     • Adjusting offerings prior to the next open enrollment
     • Identifying ways to invest strategically to retain members and limit churn
     • Detecting complaints and grievances right away to better ensure resolution

An AI Solution to Improve Star Ratings

Authenticx was built intentionally with Medicare providers in mind to help improve quality and retention with an AI-powered solution.  

Our platform uses proprietary AI models to give providers data-backed insights to drive strategic business decisions, improve member retention, and superior service experiences.

Learn more about our work with Medicare Advantage providers by reading this success story. 

About Authenticx

Authenticx is the new standard for humanizing conversational intelligence in healthcare by analyzing millions of customer interactions (like voice, chat, or emails) to surface immersive and intelligent insights at scale. Authenticx was founded to aggregate, analyze and activate customer interaction data to surface transformational opportunities in healthcare. Using existing data that’s likely being stored and ignored in your organization, Authenticx reveals hidden barriers, motivators, and strategies so healthcare organizations can make confident, data-backed decisions. In 2023, Authenticx was ranked No. 349 on the Inc. 5000 recognized as one of America and Indiana’s fastest-growing private companies. 

Want to learn more? Contact us! 

Or connect with us on social! LinkedIn | Facebook | Twitter/X | Instagram | YouTube