Georgia Medicare Quality Bonus Payment Program (QBP) Guide 2026

The Medicare Advantage Quality Bonus Payment Program (QBP) is the federal mechanism that pays Medicare Advantage organizations additional capitation based on the plan's CMS Quality Star Rating. For Georgia beneficiaries, the QBP is the financial engine behind the supplemental benefits, low cost-sharing, and broad networks that show up when you compare plans during the Annual Enrollment Period (AEP) on Medicare Plan Finder.

By Brevy Care Team · Last verified May 14, 2026

What the Medicare Advantage Quality Bonus Payment Program Is

The Quality Bonus Payment Program is the federal Star Rating-driven financial mechanism that pays Medicare Advantage organizations additional capitation payments based on the plan's CMS Quality Star Rating. The QBP translates abstract quality measurement (the 5-star rating system) into real plan revenue, and that revenue, in turn, drives benefit design decisions that affect every Georgia Medicare Advantage enrollee.

Plans rated at the higher end of the Star Rating scale receive a bonus on the benchmark used to calculate their capitation payment. In CMS-designated Double Bonus Counties, that bonus is increased further. The result is that a higher-rated plan operating in a Double Bonus County receives substantially higher CMS capitation per enrollee than a lower-rated plan operating in a standard county. For the exact bonus percentages and the current-year Double Bonus county designations, consult the current CMS Medicare Advantage Rate Announcement.

The QBP is codified in the Social Security Act and implemented in CMS regulations at 42 CFR Part 422. It was created by the Affordable Care Act of 2010 and has been refined by subsequent legislation and annual CMS rulemaking. The core mechanism (bonus for higher-rated plans, doubled in designated counties, with rebate retention scaling by Star Rating) has been the consistent foundation of Medicare Advantage quality-linked payment for over a decade.

The QBP affects Georgia Medicare Advantage enrollees indirectly through its impact on plan revenue, benefit richness, and provider network investment. Every MA-PD or MA-only plan operating in Georgia has its plan revenue partially determined by:

1. The plan's CMS Quality Star Rating (released annually in October)
2. Whether the plan operates in a Double Bonus County (CMS-designated annually)
3. The plan's bid submission to CMS each year under federal MA bid regulations
4. The plan's Medical Loss Ratio (MLR) compliance under federal MA regulations (separate but operationally aligned with QBP-incentivized quality investment)

Understanding the QBP matters because the Star Rating that drives QBP also drives the plan's revenue, which in turn drives the plan's ability to offer rich supplemental benefits, broad provider networks, and low cost-sharing. When a Georgia beneficiary chooses between a 5-star plan and a lower-rated plan during AEP, they are choosing between two plans operating on different economic footings.

Why the Quality Bonus Payment Program Matters in Georgia

The QBP matters in Georgia because:

Every Georgia MA enrollee benefits indirectly. Each Georgia Medicare Advantage enrollee's plan is paid partially on Star Rating-driven QBP. Higher-rated plans have more revenue to deploy into benefits, networks, and member services.

Some Georgia counties are Double Bonus Counties. CMS designates Double Bonus Counties based on historical Medicare fee-for-service spending patterns and MA penetration. The list is updated annually. For Georgia, several rural and lower-penetration counties have historically been designated as Double Bonus Counties at various points, though the specific designations change year-over-year. The current-year list is published in the CMS Rate Announcement.

QBP coordinates with the Medical Loss Ratio (MLR). Quality Improvement Activities (QIA) investments (care coordination, disease management, preventive care, patient safety, member experience improvements) count toward both the federal MLR floor and toward the Star Rating that drives QBP. The incentives are aligned: a plan that invests in QIA both protects itself from MLR remittance penalty and earns higher Star Ratings.

QBP unlocks rich supplemental benefits. In addition to the bonus payment itself, higher-rated plans retain a larger share of "bid savings" (the difference between the plan's bid and the CMS benchmark). The combination of QBP bonus revenue and larger rebate retention is what allows top-rated plans to offer the dental, vision, hearing, OTC allowance, transportation, fitness, and meal benefits that beneficiaries actually shop on.

5-star plans qualify for the year-round 5-Star SEP. A separate but QBP-adjacent benefit of 5-star status is the 5-Star Special Enrollment Period, which allows beneficiaries to switch into a 5-star plan once per cycle outside the standard AEP/MA OEP windows.

QBP shapes plan availability in Georgia. In rural Georgia counties, the combination of QBP, Double Bonus designation, and MLR economics drives which plans choose to enter or remain in the market. Some rural Georgia counties have fewer MA plans available specifically because the underlying economics (without QBP and Double Bonus uplift) would not sustain robust competition.

For Georgia eldercare specifically:

• A substantial Medicare beneficiary population statewide, with a meaningful share enrolled in Medicare Advantage
• Major Georgia plans (Humana, UnitedHealthcare, Aetna, Anthem, Wellcare, Cigna, Kaiser Permanente Georgia, Alignment Health Plan) compete partly on Star Ratings to capture QBP
• Some Georgia counties designated as Double Bonus Counties (varies year-to-year per CMS Rate Announcement)
• GeorgiaCares SHIP at 1-866-552-4464 provides free QBP education
• Georgia Senior Medicare Patrol at 1-866-552-4464 addresses QBP-related marketing fraud

Federal Legal Framework

The QBP rests on the following federal statutory and regulatory framework:

• The Medicare Advantage payment statute contains the QBP authority providing for additional payments to MA organizations based on quality ratings.
• CMS implementing regulations under federal MA payment rules detail the bonus calculation, Star Rating thresholds, Double Bonus County designation methodology, rebate retention structure, and operational coordination with the MA bid process.
• The Affordable Care Act of 2010 created the QBP framework; subsequent legislation and annual CMS rulemaking have modified specific QBP parameters.
• The CMS Annual Call Letter and Rate Announcement publish current-year policy guidance updating QBP parameters, Double Bonus County designations, Star Ratings methodology, and bid process requirements.
• CMS Quality Star Ratings methodology is the rating system that drives QBP. Star Ratings are calculated across a broad set of measures spanning HEDIS, CAHPS, HOS, and CMS administrative data, weighted into Part C and Part D summary ratings, and combined into the overall plan-level Star Rating released annually in October.
• Federal MA bid regulations govern the bid process. Plans submit bids to CMS on the annual schedule set by CMS, and the bid integrates expected QBP into the plan's revenue projection.
• Federal MA capitation regulations specify how CMS calculates MA capitation, including QBP additions.
• The MA Medical Loss Ratio rules require plans to spend at least 85 percent of premium revenue on incurred claims plus quality improvement activities. QIA spending coordinates with the Star Rating drivers of QBP.
• Federal Medicare Advantage statute and regulations authorize the 5-Star Special Enrollment Period, which lets beneficiaries enroll in 5-star plans year-round.

For the exact statutory subsections, the operative bonus percentages, the current Double Bonus County list, and the current bid-submission deadline, consult the CMS Medicare Advantage Rates and Statistics page and the current CMS Annual Rate Announcement.

Star Rating to Bonus Translation

The QBP translates Star Ratings into bonus payments along the following structure. For the exact percentages applicable to the current contract year, refer to the current CMS Rate Announcement.

Key observations:

• The bonus is binary at the 4-star threshold. Plans rated below 4 stars receive no QBP bonus. Plans rated 4.0, 4.5, or 5.0 stars all receive the standard QBP bonus (and the Double Bonus in designated counties). This creates a strong incentive to clear the 4-star threshold, but no marginal QBP gain from pushing from 4.0 to 4.5 to 5.0.

• 5-star status adds the 5-Star SEP, which is operationally distinct from the bonus itself but is a related quality-linked benefit. A 5-star plan can enroll members year-round (subject to the once-per-cycle rule) while non-5-star plans are limited to AEP, MA OEP, IEP, and standard SEPs.

• New plans get a special tier during their initial contract years before they have enough operational history to earn a Star Rating. This tier ensures new market entrants are not penalized purely for being new, though it is lower than the bonus that established 4-plus star plans receive.

• Just-below-4-star plans get nothing. The cliff between 3.5 and 4.0 stars is where the entire QBP bonus disappears. A plan that drops from 4.0 to 3.5 stars year-over-year loses the QBP bonus, which can translate into substantial revenue loss depending on enrollment.

Rebate Retention Structure

In addition to the bonus payment itself, higher-rated plans retain a larger share of "bid savings" (the difference between the plan's bid and the CMS benchmark). This rebate retention structure is operationally critical because the rebate funds supplemental benefits: dental, vision, hearing, OTC allowance, transportation, meals, fitness, in-home support, and similar non-Medicare benefits.

For the exact retention percentages applicable to the current contract year, consult the current CMS Rate Announcement. The remaining percentage returns to CMS (and thus to the Medicare Trust Fund) rather than being deployed for member benefits.

This is why higher-rated plans almost always offer richer supplemental benefits than lower-rated plans:

• Higher bonus (in designated counties, a doubled bonus) means more total revenue
• Higher rebate retention means more of the bid savings stay with the plan
• More revenue to deploy means richer supplemental benefits, lower cost-sharing, broader networks

A Georgia beneficiary comparing a 5-star plan and a 3.5-star plan during AEP is comparing two plans operating on materially different economic terms, and that is reflected in the benefit comparison.

Georgia Double Bonus Counties

CMS designates Double Bonus Counties based on historical Medicare fee-for-service spending patterns and MA penetration. The list is updated annually as part of the CMS Annual Call Letter and Rate Announcement process.

For Georgia, several rural and lower-penetration counties have historically been designated as Double Bonus Counties at various points, though the specific designations change year-over-year. Beneficiaries should not assume their county is or is not a Double Bonus County. The determination is made annually by CMS and is visible in the rate calculations rather than in plan marketing materials.

The Double Bonus designation is operationally important because:

• A 4-plus star plan in a Double Bonus County receives a doubled QBP bonus relative to a standard county
• This allows higher-rated plans to offer richer supplemental benefits in those counties
• Beneficiaries in Double Bonus Counties may see broader plan availability because the economics support more competing entrants
• Plan marketing in Double Bonus Counties is often more aggressive because plan revenue per enrollee is higher

For Georgia specifically, the Double Bonus County dynamic is relevant in rural counties where the underlying Medicare FFS spending is lower. Whether your specific Georgia county is a Double Bonus County in any given year requires checking the current-year CMS Rate Announcement, but the operational effect (richer benefits, more plan competition) is the same wherever Double Bonus designation applies.

How the QBP Integrates with the MA Bid Process

The MA bid process is the annual cycle by which Medicare Advantage organizations submit their proposed plan benefits, premiums, and cost-sharing to CMS. The bid process operates on a calendar:

• Spring/early summer: Plans submit bids to CMS per the federal MA bid deadline. The bid specifies projected medical and prescription drug costs (incurred claims), projected QIA spending, projected administrative costs (subject to MLR), projected profit, premium structure (Part C premium, Part D premium, optional supplemental premium), cost-sharing design (copays, coinsurance, MOOP), and supplemental benefits (funded from rebate retention).
• Summer: CMS reviews and approves bids.
• September: Plans file their Annual Notice of Change (ANOC) for the following plan year, reflecting CMS-approved bids.
• October 1: Plan Finder updates with following-year plan data.
• October: CMS releases annual Star Ratings, which inform QBP for the next contract year.
• AEP: Annual Enrollment Period runs each fall. Beneficiaries choose plans for the following plan year. Verify current-year dates on Medicare.gov.
• January 1: New plan year begins. QBP-driven capitation flows to plans based on prior-year Star Ratings.
• MA OEP: Medicare Advantage Open Enrollment Period for current-year MA enrollees runs in the new year.

The QBP is integrated into the bid process because plans estimate their expected QBP revenue (based on their projected Star Rating) when constructing their bid. A plan currently rated 4.5 stars that is confident it will retain 4-plus stars next year will incorporate the expected bonus into its revenue projections, which allows it to bid more competitively on benefits and cost-sharing.

A plan currently rated 3.5 stars that is unsure whether it can clear 4 stars next year faces uncertainty: if it bids assuming the bonus and the Star Rating drops below 4, the actual revenue will not cover the projected benefits. Plans manage this uncertainty by being conservative on bid components that depend on bonus revenue, which is why 3.5-star plans typically offer leaner supplemental benefits than 4-plus star plans.

How the QBP Coordinates with the Medical Loss Ratio (MLR)

The QBP and the MLR (covered in our companion guide) are separate regulations but operationally aligned:

• MLR requires MA plans to maintain a medical loss ratio of at least 85 percent: at least 85 cents of every premium dollar must go to incurred claims plus QIA, with the remainder capped on administration, marketing, profit, and overhead.
• QBP rewards plans for higher Star Ratings, which are themselves driven significantly by QIA-related performance.

The shared pathway is Quality Improvement Activities (QIA). QIA spending counts toward:

• MLR numerator (helping the plan meet the federal floor)
• Star Rating performance (improving HEDIS, CAHPS, HOS scores)
• Star Rating leading to QBP (clearing 4 stars unlocks the bonus)

A plan that invests heavily in QIA (care coordination, disease management programs for diabetes, heart failure, COPD, preventive care outreach, patient safety initiatives, member experience improvements, health IT, telehealth, e-prescribing) both protects itself from MLR remittance penalty AND positions itself for higher Star Ratings AND thus higher QBP.

This is why MA plans have rationalized aggressive QIA investment over the past decade: the same dollar spent on care coordination simultaneously serves MLR compliance, Star Rating improvement, QBP revenue maximization, and member retention.

For Georgia beneficiaries, the practical implication is that when a Georgia MA plan offers a structured disease management program, a 24/7 nurse line, a member health risk assessment, a fall prevention program, or any other QIA-categorized intervention, engaging with it serves your interests because (a) you get the care benefit and (b) it strengthens the plan's economics, which sustains the broader benefit package.

How the QBP Coordinates with the 5-Star Special Enrollment Period

The 5-Star SEP is a separate special enrollment period that allows beneficiaries to switch into a 5-star plan once per cycle outside the standard AEP/MA OEP windows.

The 5-Star SEP and the QBP are related but distinct:

• The QBP bonus is the same standard percentage for 4.0, 4.5, and 5.0 star plans
• The 5-Star SEP is uniquely available only for 5.0-star plans

So while a 4-star plan and a 5-star plan get the same QBP bonus, the 5-star plan has the additional marketing advantage of year-round 5-Star SEP enrollment. This is why some plans aggressively target the 5-star tier even though the marginal QBP does not increase between 4.0 and 5.0 stars: the SEP advantage is meaningful for enrollment growth.

For Georgia beneficiaries:

• If a 5-star plan is available in your county and meets your needs, you can switch into it year-round using the 5-Star SEP
• The 5-Star SEP can be used once per cycle
• The switch is generally effective the first of the following month
• Star Ratings are updated annually in October, so a plan's 5-star status can change year-over-year

QBP-Driven Benefit Richness in Georgia

The combination of QBP bonus and rebate retention drives the benefit richness gap that Georgia beneficiaries observe when comparing plans during AEP.

Higher-rated (4-plus star) Georgia MA plans typically offer:

• Comprehensive dental coverage including cleanings and major services
• Robust vision coverage including frames, exam, and contacts
• Hearing aid allowances
• Quarterly OTC allowance
• Transportation benefits with a set number of one-way trips annually
• Post-discharge meal benefits
• Fitness benefits (such as Silver Sneakers or equivalent)
• $0 or low monthly premium
• Lower MOOP
• Broad provider networks

Lower-rated (3-3.5 star) Georgia MA plans typically offer:

• Limited dental coverage
• Modest vision coverage
• Limited or no hearing aid coverage
• Smaller OTC allowance
• Less generous transportation
• Higher premium or higher cost-sharing
• Tighter networks

For current allowance amounts and trip counts, compare specific plans on Medicare Plan Finder at AEP.

The cause is economic: the 4-plus star plan has a QBP bonus on top of the benchmark, plus a higher share of bid savings. That extra revenue gets deployed back into supplemental benefits.

This is why Georgia beneficiaries who select higher-rated plans typically receive richer benefit packages. It is not a coincidence; it is a direct consequence of how QBP and rebate retention are structured.

Georgia QBP Context

For Georgia specifically:

Statewide Medicare population. Georgia has a substantial Medicare beneficiary population, with a meaningful share enrolled in Medicare Advantage. The exact enrollment shifts year-to-year as MA penetration grows. For current Georgia enrollment figures, see the CMS Medicare Enrollment Dashboard.

Major Georgia MA plans subject to QBP:

• Humana
• UnitedHealthcare
• Aetna (CVS Health)
• Anthem (Elevance Health)
• Wellcare (Centene)
• Cigna
• Kaiser Permanente Georgia
• Alignment Health Plan
• Devoted Health (in some Georgia counties)

Each of these plans operates with a Star Rating released annually in October. Higher-rated plans capture QBP; lower-rated plans do not.

Georgia Double Bonus County context. Some Georgia counties have historically been designated as Double Bonus Counties (the exact list varies year-to-year per CMS Annual Call Letter). Counties more likely to be designated include rural counties with lower MA penetration and lower historical Medicare FFS spending. Beneficiaries in those counties may see broader plan availability and richer supplemental benefits from 4-plus star plans operating there.

GeorgiaCares SHIP at 1-866-552-4464 provides free, unbiased counseling on QBP education, Star Rating interpretation, plan selection, and AEP / MA OEP / 5-Star SEP timing.

Georgia Senior Medicare Patrol at 1-866-552-4464 addresses QBP-related marketing fraud. Some marketers misrepresent Star Ratings or QBP-driven benefits in violation of CMS Medicare Communications and Marketing Guidelines (MCMG). Report violations to SMP.

Best Practices for Georgia Beneficiaries Navigating QBP-Driven Plan Selection

1. Check Star Ratings every October before AEP begins. Star Ratings are released annually around October and drive QBP for the following contract year.

2. Do not confuse "the bonus" with "your benefit." The QBP is paid to the plan, not to you directly. You experience the QBP through the plan's benefit richness, not through a check in the mail.

3. Compare 4-plus star plans first when shopping during AEP. These plans receive the QBP bonus and the higher rebate retention tier, which typically translates to richer benefits.

4. Use Plan Finder on Medicare.gov to filter plans by Star Rating during AEP. This puts higher-rated, QBP-eligible plans at the top of your comparison.

5. Look at trend, not just current Star Rating. A plan that has held 4-5 stars for several years is more reliable than a plan that just jumped from 3.5 to 4 (which could regress).

6. Engage with plan QIA programs. Disease management, care coordination, member health risk assessments benefit you directly AND strengthen the plan's Star Rating AND thus sustain its QBP-driven benefit package.

7. Use the 5-Star SEP if a 5-star plan becomes available in your county. The 5-Star SEP allows year-round enrollment, once per cycle, generally effective the first of the following month.

8. Verify your provider is in-network before switching to a higher-rated plan. QBP does not help if your PCP or specialist is not in the plan's network.

9. Watch for Double Bonus County status in your area. If you live in a Double Bonus County, 4-plus star plans there receive a doubled bonus. Expect richer benefits than the same plans offer in standard counties.

10. Read the ANOC carefully each September. The ANOC describes changes for the following plan year, including any benefit reductions that might signal Star Rating regression or QBP loss.

11. Do not switch just for Star Rating. Also evaluate provider network, formulary, pharmacy access, MOOP, and total annual out-of-pocket cost. A 5-star plan with a narrow network you cannot use is not better than a 4-star plan with your providers in-network.

12. Use GeorgiaCares SHIP at 1-866-552-4464 for free counseling. SHIP counselors can explain how Star Ratings drive QBP and help you compare plans on a quality-and-economics basis.

13. Report misleading QBP marketing to the Georgia Senior Medicare Patrol at 1-866-552-4464. Some marketers misrepresent Star Ratings or imply QBP equals direct beneficiary benefits, which violates CMS marketing rules.

14. Re-evaluate annually. Star Ratings change year-over-year. A plan that is 4-star this year might be 3.5-star next year (or vice versa), which changes the QBP economics underlying its benefits.

Common Issues Georgia Beneficiaries Face with QBP-Driven Plan Selection

1. "I thought the bonus was paid to me." No. The QBP is paid to the plan, not the enrollee. You experience the QBP through the plan's benefit richness, not directly.

2. "My plan dropped from 4 to 3.5 stars. What happens?" The plan loses the QBP bonus for the next contract year. You may see benefit reductions or premium increases in the following year's ANOC.

3. "I'm confused about whether my county is a Double Bonus County." The list is published annually in the CMS Rate Announcement but is not typically marketed by plans. Call GeorgiaCares SHIP at 1-866-552-4464 for help interpreting current-year designations.

4. "All 4-star plans get the same bonus. Why are some plans better?" Because the QBP is just one revenue input. Plans differ on MLR efficiency, network depth, pharmacy contracts, administrative scale, and supplemental benefit design.

5. "A new plan offered me bigger benefits than the 5-star plan." Possible but unsustainable. New plans get a special tier for their initial contract years, but after that, they need to clear 4 stars or lose bonus revenue. If the new plan does not earn 4 stars by the end of the new-plan window, benefit cuts likely follow.

6. "My 5-star plan stopped offering year-round 5-Star SEP." Star Ratings can change. If your plan dropped below 5 stars, it lost 5-Star SEP eligibility for the affected contract year.

7. "I missed AEP. Can I still switch using the 5-Star SEP?" Only if a 5-star plan is available in your county. The 5-Star SEP requires a 5.0-star rated plan in your service area.

8. "My plan's marketing material claims 'bonus benefits.'" Be cautious. CMS regulates how plans market QBP. Call GeorgiaCares SHIP at 1-866-552-4464 to verify claims, or report violations to the Georgia Senior Medicare Patrol.

9. "I cannot compare plans on Star Rating alone." Correct. Star Rating is a useful but partial signal. Always also evaluate provider network, formulary, pharmacy, MOOP, premium, and total cost.

10. "My PCP isn't in any 5-star plan." Trade-off decision. Sometimes the right answer is to stay with the lower-rated plan that includes your PCP. Other times, switching PCPs is worth it to access a higher-rated plan.

11. "I'm in a rural Georgia county with few MA plans." QBP economics partly drive this. In some rural counties, the underlying Medicare FFS rate is too low to sustain robust MA competition. Original Medicare plus Medigap plus standalone Part D may be a better path.

12. "The 5-star plan is more restrictive on prior authorization." Possible. Higher-rated plans are not always less restrictive. Read the Evidence of Coverage and Summary of Benefits.

13. "I selected a 4-star plan but my benefits got cut in Year 2." Check the ANOC. The plan may have lost 4-star status (and thus QBP) for the new contract year, forcing benefit reductions.

14. "I don't know what 'rebate retention' means." It means the plan keeps a larger share of bid savings if it has a higher Star Rating, and that larger share funds supplemental benefits. You do not need to track rebate retention directly. It is reflected in the supplemental benefits you see.

Worked Examples

Example 1: Margaret in Fulton County, AEP Plan Comparison Using QBP-Driven Benefits

Margaret, age 67, lives in Atlanta (Fulton County) and is comparing plans during AEP for the next plan year. She narrows to two finalists:

• Plan A: 5.0 stars (held 5 stars for four consecutive years), $0 premium, comprehensive dental, robust OTC allowance, hearing aid coverage, broad network including her PCP
• Plan B: 3.5 stars (just dropped from 4 stars), $0 premium, modest dental, smaller OTC allowance, no hearing aid coverage, narrower network

Margaret understands that Plan A's benefit richness reflects its 5-star QBP economics: standard QBP bonus plus the top rebate retention tier. Plan B lost the QBP bonus when it dropped below 4 stars and now retains a smaller share of bid savings. The benefit difference is not accidental; it is structural.

Margaret selects Plan A. She also notes that as a 5-star plan, Plan A would be available via the 5-Star SEP year-round if she wanted to switch back to it after a future AEP departure (assuming Plan A retains 5-star status).

Example 2: James in DeKalb County, Beneficiary in a Designated Double Bonus County

James, age 70, lives in a part of DeKalb County that CMS has designated as a Double Bonus County for the current rate year. James notices that the 4-plus star MA plans available in his ZIP code offer notably richer supplemental benefits than the same plans offered in neighboring counties.

James calls GeorgiaCares SHIP at 1-866-552-4464. The SHIP counselor explains:

• His county's Double Bonus designation means 4-plus star plans receive a doubled bonus relative to standard counties
• That higher capitation per enrollee allows plans to offer richer dental, vision, OTC, and transportation benefits
• The Double Bonus designation is reviewed annually and could change
• James should focus his comparison on 4-plus star plans (the ones getting the double bonus) and compare their supplemental benefit packages

James selects a 4.5-star plan with strong supplemental benefits funded by the Double Bonus economics.

Example 3: Robert in Cobb County, Understanding Rich Supplemental Benefits via QBP

Robert, age 68, lives in Cobb County and notices that his 5-star plan offers far richer benefits than friends' lower-rated plans: hearing aids covered, comprehensive dental, generous OTC, transportation, fitness, $0 premium.

Robert reads about the QBP and understands the economics. His plan earns the standard QBP bonus (because it is 4-plus stars) and retains the highest share of bid savings (because it is 4-plus stars). The 5-star rating itself does not add bonus revenue beyond 4 stars, but it adds the 5-Star SEP marketing advantage that grows enrollment and economies of scale.

Robert engages actively with the plan's QIA programs: the diabetes management program, the annual member health risk assessment, the 24/7 nurse line. He recognizes that his participation supports the plan's Star Rating, which sustains the QBP economics, which sustains his benefit package.

Example 4: Linda in Worth County, Rural Beneficiary and QBP Impact on Plan Availability

Linda, age 72, lives in Worth County, a rural South Georgia county with limited MA plan availability. The plans serving her ZIP code are clustered in the lower Star Rating tiers, and no 4-plus star plans serve Worth County.

Linda calls GeorgiaCares SHIP at 1-866-552-4464 to understand why the rural options are limited. The counselor explains:

• Worth County has lower Medicare FFS reimbursement and lower MA penetration than Atlanta metro
• Lower benchmark rates make MA economics tighter in rural counties
• Plans need scale plus favorable bid-to-benchmark dynamics to operate profitably
• Some rural Georgia counties are designated as Double Bonus Counties (which would attract more plans); Worth County's designation varies year-to-year
• Without 4-plus star plans available, Linda is choosing between plans that do not capture QBP

The SHIP counselor walks Linda through her alternatives:

• Original Medicare plus a Plan G Medigap policy (Anthem or another Georgia-licensed carrier) plus a standalone Part D PDP
• One of the available MA plans (no QBP-driven benefit richness, but low or zero premium)

Linda elects Original Medicare plus Plan G plus a Part D PDP, preferring predictable cost-sharing and broad provider access over the lean MA options.

Example 5: David in Bibb County, Using the 5-Star SEP for Year-Round Enrollment

David, age 69, lives in Macon (Bibb County) and during the prior AEP enrolled in a 4-star MA plan. Mid-year, he reads about a 5-star plan that just earned that status and is available in Bibb County. The 5-star plan has stronger supplemental benefits, including the dental coverage David needs after starting major dental work.

David calls GeorgiaCares SHIP at 1-866-552-4464. The counselor confirms:

• The 5-Star SEP allows David to switch into the 5-star plan year-round, outside AEP/MA OEP
• The 5-Star SEP can be used once per cycle
• The switch is generally effective the first of the following month
• David should confirm his providers and medications are covered before switching

David verifies his PCP and specialists are in-network with the 5-star plan, confirms his medications are on its formulary, and uses the 5-Star SEP to switch.

Example 6: Sarah in Hall County, First AEP Using a QBP-Driven Benefit Comparison

Sarah, age 65, enrolls in Medicare during her IEP and uses her first AEP to systematically compare MA plans available in Hall County (Gainesville area). She uses the QBP framework to structure her comparison:

• Plan A: 4.5 stars, has held 4-plus stars for three years, $0 premium, comprehensive dental, broad network including her PCP and specialists
• Plan B: 4.0 stars (just upgraded from 3.5), $0 premium, moderate dental, broad network
• Plan C: 3.5 stars, $0 premium, modest dental, broad network
• Plan D: 3.0 stars, $0 premium, minimal dental, broad network

Sarah understands the QBP economics. Plans A and B both clear the 4-star threshold and receive the QBP bonus plus the top rebate retention tier (which is why their supplemental benefits are richer). Plan C is in the middle rebate retention tier but earns no QBP bonus. Plan D is in the lowest rebate retention tier and earns no QBP bonus.

But Sarah also notes that Plan B just jumped from 3.5 to 4 stars, which is encouraging but unproven over time. Plan A has held 4-plus stars consistently for three years, which is more reliable.

Sarah selects Plan A. She schedules her annual Medicare review with GeorgiaCares SHIP for the following October, when next-year Star Ratings will be released.

A few more common questions Georgia beneficiaries ask:

Who is eligible for the QBP bonus? Medicare Advantage organizations whose plans clear the 4-star threshold. Plans rated below that receive no QBP bonus. New plans get a special tier during their initial contract years.

What's the difference between standard bonus and Double Bonus? The standard bonus is added to the benchmark for 4-plus star plans. The Double Bonus doubles that uplift for 4-plus star plans operating in CMS-designated Double Bonus Counties (rural and lower-penetration counties with specific historical patterns). For exact percentages, see the current CMS Rate Announcement.

When are Star Ratings released? Each October, for the following contract year. Star Ratings released in October affect the next contract year's QBP and the Plan Finder displays beneficiaries see at AEP.

Do all 4-star plans get the same bonus? Yes. All plans rated 4.0, 4.5, or 5.0 stars receive the standard QBP bonus (or the Double Bonus in designated counties). The benefit difference between 4-star and 5-star plans is not QBP magnitude; it is other factors (efficiency, scale, member experience investment, etc.).

When do plans submit bids? On the annual deadline set by CMS under federal MA bid regulations. Bids are reviewed by CMS over the summer, ANOC files in September, and Plan Finder updates October 1.

How does QBP coordinate with MLR? Quality Improvement Activities (care coordination, disease management, preventive care) count toward both MLR (helping meet the federal floor) and Star Rating performance (driving QBP). The incentives are aligned.

What is the "new plan" special tier? Plans in their initial contract years do not yet have a Star Rating because they lack operational history. CMS provides a special bonus tier during this period. After the new-plan window ends, the plan must earn its own Star Rating.

Does QBP affect Original Medicare beneficiaries? No. QBP applies only to Medicare Advantage organizations. Original Medicare (Parts A and B) operates on a fee-for-service basis without QBP.

Does QBP affect standalone Part D PDPs? No. QBP applies to MA-PD and MA-only plans, not to standalone Part D PDPs. Part D PDPs have their own Star Rating system but do not receive QBP bonuses in the same structure.

Can a plan lose QBP status mid-year? No. QBP is based on the Star Rating in effect at the start of the contract year (set by Star Ratings released the prior October). A plan's Star Rating does not change mid-contract-year. Changes apply to the next contract year.

What's the difference between Part C Star Rating and Part D Star Rating? MA-PD plans have separate Part C (medical) and Part D (drug) summary ratings, combined into an overall plan-level rating. The QBP is based on the overall plan-level rating for MA-PD plans.

Are plan rebates the same as QBP bonuses? No. The QBP bonus is added to the benchmark calculation. Rebates are the difference between the plan's bid and the benchmark, with higher-rated plans retaining a larger share of that difference.

Does QBP make 4-plus star plans always better? Not always. QBP-driven economics make higher-rated plans likely to offer richer benefits, but other factors (provider network, formulary, prior authorization patterns, member service quality, geographic access) also matter. Use Star Rating as one input among many.

Where can I learn more about QBP in Georgia? GeorgiaCares SHIP at 1-866-552-4464 provides free QBP education and counseling. The CMS Annual Call Letter and Rate Announcement detail the technical mechanics. Medicare.gov has consumer-friendly explanations.

How do I report misleading QBP marketing in Georgia? Call the Georgia Senior Medicare Patrol at 1-866-552-4464. Misrepresentation of Star Ratings, QBP-driven benefits, or any implication that the bonus is paid directly to beneficiaries violates CMS Medicare Communications and Marketing Guidelines.

Phone Numbers and Resources

• Medicare 1-800-MEDICARE (1-800-633-4227), federal Medicare hotline
• Social Security Administration Medicare Enrollment 1-800-772-1213
• GeorgiaCares SHIP 1-866-552-4464, free QBP education and plan counseling
• Georgia Senior Medicare Patrol 1-866-552-4464, QBP-related marketing fraud detection
• Medicare Rights Center 1-800-333-4114, national Medicare advocacy
• Georgia Department of Community Health Member Services 1-866-211-0950
• Atlanta Legal Aid Society 404-377-0701, free legal services for Atlanta metro seniors
• Georgia Legal Services Program 1-800-498-9469, free legal services outside Atlanta
• Eldercare Locator 1-800-677-1116, connects to Georgia AAAs
• 211 Georgia, community resource referrals
• Patient Advocate Foundation 1-800-532-5274, case management for serious illness

This guide is for educational purposes and does not constitute legal, financial, or medical advice. Consult licensed professionals and CMS resources for personalized guidance.

Find personalized help comparing Georgia Medicare Advantage plans and understanding the Quality Bonus Payment Program at brevy.com.