Medicare's quality bonus tab keeps growing. The federal government is set to pay out $13.4 billion to Medicare Advantage plans in 2026 — more than four times what it spent in 2015 — even as fewer enrollees are in bonus-eligible plans. Critics say the program is ripe for reform, but changes on the horizon could push spending even higher.
Medicare's quality bonus bill keeps climbing. The federal government will spend at least $13.4 billion on Medicare Advantage (MA) quality bonus payments in 2026, up from $12.7 billion in 2025 and more than four times the $3 billion paid out in 2015, according to a new KFF analysis. The payments are tied to CMS's star ratings program, with plans earning four or more stars qualifying for the extra cash.
Here's the twist: even as the dollar amount grows, fewer seniors are actually in bonus-eligible plans. Just 68% of MA enrollees — about 24 million people — are in qualifying plans this year, down from 75% in 2025 and the lowest share since 2018. The Congressional Budget Office estimated in 2018 that eliminating the program entirely could save nearly $100 billion over a decade, a figure KFF says is likely an undercount given MA's explosive enrollment growth since then.
By the Numbers:
Why it matters: With Medicare's key trust fund projected to run dry by 2033, the quality bonus program's escalating costs are drawing fresh scrutiny. Yet upcoming regulatory changes are poised to send even more money to insurers — making meaningful reform an uphill battle.
