MCAHPS 2025: Your guide to the latest changes
The Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) survey is an essential tool for evaluating Medicare Advantage (MA) and Prescription Drug Plan (PDP) enrollees' satisfaction with their health plans and providers. Just like last year’s MCAHPS 2024, some significant changes are coming in 2025.
MCAHPS overview: What’s staying the same in 2025?
The MCAHPS survey remains a critical part of the Medicare Advantage program, providing valuable insights into enrollees' experiences with their health plans. In 2025, Medicare Advantage and PDP contracts with 600 or more enrollees will still be required to conduct the survey.
A sample of Medicare enrollees—who are at least 18 years old, have been continuously enrolled for six+ months, and are living in the U.S.—will be selected to participate. CMS uses its monthly enrollment data to identify eligible participants, ensuring a broad and representative sample. Enrollees who are institutionalized at the time of the sample draw will be excluded from the survey.
While participation is mandatory for larger contracts, smaller plans with fewer than 600 enrollees can still voluntarily participate. Whether the survey is mandatory or voluntary, the results will play a role in determining the plan’s Medicare Star Ratings.
Key updates for MCAHPS 2025: Survey administration
One of the most significant updates for the 2025 survey is the introduction of a QR code-based response option. This lets enrollees complete the survey online using the QR code provided in pre-notification and web survey invitation letter. Press Ganey, which supports many Medicare Advantage plans, has advocated for this change based on its success in increasing response rates in other CAHPS surveys.
The web-based option will join traditional survey methods, like mail and telephone (also known as computer-assisted telephone interviewing, or CATI), making it more accessible to a broader audience. Plans looking to boost survey responses should ensure enrollees’ email addresses are up to date. Collecting valid email addresses from members via several different touch points and coordinating with provider partners to collect accurate email addresses will be essential for this new web-based format’s success.
MCAHPS 2025: Changes to survey questions
In addition to updates to survey administration, three questions are being eliminated from the 2025 MA-only and MA-PD CAHPS versions:
- Q8: "Wait time includes time spent in the waiting room and exam room. In the last six months, how often did you see the person you came to see within 15 minutes of your appointment time?"
- Q55 (MA-only), Q60 (MA-PD): "Do you now smoke cigarettes or use tobacco every day, some days, or not at all?"
- Q56 (MA-only), Q61 (MA-PD): "In the last six months, how often were you advised to quit smoking or using tobacco by a doctor or other health provider?"
These changes streamline survey questions to better align with the core objectives of measuring enrollee satisfaction and engagement with their healthcare providers and plans.
Updates to survey materials
Participants and health plans should note a few important updates to the survey materials too:
- Pre-notification and web survey invitation letters: These letters will now include a QR code with a URL and enrollee-specific PIN for easy online survey access.
- CATI survey scripts: The introduction screens in the CATI scripts will be more concise, and emphasize that the call isn’t a sales pitch, creating a smoother participant experience.
These changes are all designed to enhance the overall user experience and increase survey completion rates.
Sample selection for MA–PD plans
For the 2025 MCAHPS survey, CMS will draw samples of current enrollees for MA and PDP contracts in January. The sample size and selection process will vary depending on the type of contract:
- For MA contracts with 800+ eligible enrollees: CMS will sample 800 cases, with the option to request a larger sample if approved in advance by CMS.
- For MA contracts with 600–799 eligible enrollees: CMS will sample all eligible cases.
- For smaller plans: Plans with fewer than 600 eligible enrollees may choose to participate, but their results will still count toward Medicare Star Ratings.
Plans must be ready to meet the sample requirements, particularly if requesting an oversample.
Supplemental questions for 2025
Health plans may submit up to 12 supplemental questions to be included in the 2025 survey. The deadline to submit these questions to CMS for review has passed, but it’s important to keep in mind that these types of questions can be submitted in future surveys. Supplemental questions must be well thought out, as they provide valuable insights into specific areas of concern or interest for the plan.
Supplemental questions must also come after the core questions and be included across all survey modes (web, mail, and CATI).
Impact on Medicare Advantage Stars 2026
Looking ahead to the Medicare Advantage Stars 2026 ratings, it’s important to note that the 2025 MCAHPS survey results will be weighted at a factor of 2, down from a factor of 4 in the 2025 Star Ratings. While the weighting has changed, member satisfaction and engagement remain at the heart of the Stars program. Happy and engaged members are more proactive about preventive care, manage their chronic conditions, take medications as prescribed, stay enrolled in the plan, and avoid unnecessary hospital visits.
Press Ganey research projects that the 2x weight reduction for CAHPS questions will significantly impact at least 21% of Medicare Advantage Prescription Drug (MAPD) contracts—especially those without improvements in other Stars performance areas. As many as 21% of MAPD contracts could be losing half of a Star overall.
While 28% of MAPD contracts may see an increase in their unrounded overall Star Rating, a significant jump of half a Star or more is expected in only 5% of contracts.
The new Health Equity Index (HEI) reward calculations will now be based on MCAHPS survey scores and other Stars measures for populations with social risk factors and disabilities. For 2027 Stars, 68% of our client contracts would see no change in their Reward Factor. However, 10% could experience a 0.1-point decline, 11% a 0.2-point decline, and nearly 6% could lose 0.3 or the full 0.4 Reward Factor under HEI. Contracts eligible for a half reward due to population size will be most affected, with 20% potentially facing a decline.
MCAHPS survey scores continue to play a role in a health plan’s performance in the Stars system. Understanding how to draw insights and impactful factors from MCAHPS survey scores will be essential for improving Star Ratings.
If you have any questions or want further assistance understanding these updates, reach out to a Press Ganey health plan expert.