Humana Says 95% of Medicare Advantage Members Are Enrolled in Plans Rated Four Stars or Higher for 2027

Humana (NYSE:HUM) reported that 95% of its Medicare Advantage members are enrolled in plans receiving quality ratings of at least four stars from the Centers for Medicare & Medicaid Services (CMS) for 2027, marking an improvement from the previous year.

The US health insurer said 42% of its Medicare Advantage membership is covered by plans awarded 4.5 stars, reflecting progress in quality measures, preventive healthcare participation and member engagement.

CMS evaluates Medicare Advantage and Medicare Part D prescription drug plans annually using a five-star rating system that considers quality of care, patient experience and customer service.

The ratings are an important measure of plan performance and can influence consumer decisions during the annual Medicare enrolment period.

Humana Reports Improvement Across Medicare Advantage Contracts

For 2027, Humana received 4.5-star ratings for six Medicare Advantage contracts, while another 12 contracts achieved four-star ratings.

The combined total represents an increase of 11 contracts rated four stars or higher compared with the previous year.

Humana also reported that its standalone Prescription Drug Plan (PDP) contract received a 4.5-star rating for 2027.

The results indicate broader improvements across the company’s Medicare Advantage portfolio, with a greater proportion of members enrolled in higher-rated plans.

CMS ratings assess several aspects of healthcare plan performance, including clinical outcomes, access to services, customer satisfaction and the management of chronic conditions.

Higher ratings can strengthen a plan’s competitive position by providing prospective members with an independent measure of service quality.

For Humana, the improved results come ahead of the annual Medicare Advantage and prescription drug plan election period, when eligible beneficiaries can review and change their coverage.

Preventive Care Initiatives Increase Member Participation

Humana attributed part of its improved performance to efforts aimed at encouraging members to complete recommended medical appointments, screenings and other preventive healthcare activities.

According to the company, an additional 663,000 care opportunities were completed compared with the previous year.

Humana also reported that 534,000 more members attended an annual preventive healthcare visit.

These visits can help healthcare providers identify potential medical concerns, review existing conditions and recommend appropriate screenings or treatment.

The company said its member engagement programmes focused on addressing gaps in preventive care, particularly among individuals who had not completed recommended examinations.

The initiatives contributed to increased participation in cancer screenings and diabetes-related eye examinations.

Cancer Screenings Identify Previously Undetected Conditions

Humana reported that its outreach programmes encouraged 28,000 members to complete overdue mammograms.

According to the insurer, those screenings identified 600 cases of breast cancer that had not previously been detected.

The company also said an additional 93,000 members completed overdue colorectal cancer screenings.

Those examinations identified 100 previously undetected cases involving precancerous conditions or colorectal cancer.

The findings demonstrate the potential role of preventive screening programmes in identifying serious medical conditions before they are otherwise diagnosed.

Early detection can provide healthcare professionals with additional opportunities to assess treatment options and manage conditions.

However, the reported figures reflect outcomes identified through Humana’s screening initiatives and do not independently establish the long-term clinical benefits of those programmes.

Diabetes Eye Examinations Detect Thousands of Cases

Humana also highlighted improvements in preventive care among members living with diabetes.

The insurer reported that an additional 73,000 members completed overdue eye examinations as a result of its engagement efforts.

These examinations identified approximately 17,000 previously undetected cases of diabetes-related eye disease.

Regular eye screening is an important component of diabetes management because the condition can affect blood vessels in the retina and lead to complications that may impair vision.

Identifying these changes can allow healthcare professionals to recommend further assessment, monitoring or treatment.

Humana said the results reflected its efforts to increase access to preventive services and encourage members to complete recommended medical examinations.

Shantanu Nundy, Humana’s Chief Medical Officer, emphasised the importance of identifying health conditions before they progress.

“Helping a member get an overdue screening means identifying a serious condition sooner, when there are more treatment options and better outcomes,” Nundy said.

Medicare Enrolment Period Begins October 15

Humana’s updated quality ratings were announced ahead of the Medicare Advantage and Prescription Drug Plan Annual Election Period.

The enrolment window opens on October 15 and continues through December 7, 2026.

Coverage selected during this period will take effect on January 1, 2027.

During the election period, eligible Medicare beneficiaries can compare available plans, review coverage options and make changes to their healthcare or prescription drug benefits.

CMS star ratings are among the factors consumers may consider when evaluating different Medicare Advantage plans.

For Humana, the increased proportion of members enrolled in plans rated four stars or higher represents an improvement in its reported quality performance ahead of the new coverage year.

The company’s results also highlight its emphasis on preventive healthcare participation and the identification of previously undetected medical conditions.

Investors will be assessing how the improved ratings affect Humana’s competitive position, membership trends and financial performance as the insurer prepares for the 2027 Medicare coverage period.

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