The 2024 measurement year brings new challenges for Medicare Advantage plans navigating the CMS Star Rating program designed to measure and incentivize high quality of care to Medicare Advantage members. Following an all-time high performance in 2022, the Star Ratings have been on a steady decline resulting in large reductions in quality bonus and rebate payments. We expect the trend to continue with several more major changes starting in the current measurement year, including a decrease in Patient Experience and Access measure weights, the new Health Equity Index reward, and the first Star Rating measure transitioning from hybrid to electronic reporting methodology. This whitepaper describes the new methodological changes impacting the 2024 measurement year, analyzes the downstream implications on Star Ratings and the associated revenue streams, and highlights the adjustments the health plans need to make to prevent further Star Rating decreases.