Texas Independence Health Plan has earned a CMS 5-Star rating for 2026 — the highest Medicare quality score, held by just 18 plans nationwide.
Every year, Medicare evaluates plans based on a 5-star rating system.
VICTORIA, Texas — In 2020, Texas Independence Health Plan (TIHP) enrolled its first members. At that time, the plan was too new to be measured.
That changed in October 2025, when the Centers for Medicare and Medicaid Services released its annual Medicare Advantage and Part D Star Ratings for 2026. TIHP received a 5-Star designation — the highest rating available — earned by 18 plans out of more than 500 evaluated. The average rating across the industry was 3.65.
TIHP is based in Victoria. It serves residents of nursing homes and skilled nursing facilities across 89 Texas counties.
“This didn’t happen because of a single initiative or a good quarter. It happened because our clinical team shows up — inside these facilities, alongside the staff who are already working hard every single day. The rating is really theirs.”
— Sandy Malone, Business Development Director, Texas Independence Health Plan
From New Plan to National Recognition
TIHP is an Institutional Special Needs Plan, or I-SNP — a Medicare Advantage plan designed for people who live in nursing homes, assisted living facilities, and skilled nursing facilities long-term (90 days or longer) within the plan’s service area. The model adds a dedicated layer of proactive clinical support: a Nurse Practitioner and an RN Care Coordinator placed directly within each partner facility, working alongside the existing staff, monitoring residents regularly, and managing health changes before they become emergencies.
The plan launched in 2020. CMS designated it as too new to be measured that first year — standard for new plans without sufficient historical data. By 2023, TIHP received a 4 star rating and was operating across 25 Texas counties. It held at a 4.5 star rating in 2024 and again in 2025. Then, based on its 2024 performance data, CMS assigned it a 5-Star rating.
The jump from 4.5 to 5 is not a small one. In 2025, only seven Medicare Advantage plans in the entire country held a 5-Star rating. This year, that number grew to 18 — still just 3.5% of all rated contracts. TIHP is one of them.
What CMS Actually Measured
CMS evaluates Medicare Advantage and Part D plans across dozens of quality measures, including the following: how well members manage chronic conditions, how often they return to the hospital, whether their medications are taken correctly, and how they rate their care. TIHP’s 2026 results stood out in several areas.
Follow-up care after an emergency department visit is one of the harder metrics to move — coordinating care across providers after a crisis requires a system that is already paying close attention. TIHP’s rate was 89.25%. The national average was 60.9%.
89% of high-risk members received follow-up care after an ER visit. National average: 60.9%.
99.93% of members had access to preventive and ambulatory health services.
98.82% had documented Advance Care Planning conversations. National average: 50.4%.
79.93% flu vaccination rate — roughly double the national Medicare HMO average of 40%.
4% of members chose to leave the plan. The industry average is considerably higher.
0.11% complaint rate against the health plan. Also 5 stars.
On medication adherence — a category that matters enormously for a population managing diabetes, heart disease, and other chronic conditions — TIHP scored 93% for diabetes medications, 94% for hypertension, and 96% for cholesterol management. All three earned 5 stars.
What the Rating Means Beyond the Scorecard
For nursing home administrators and long-term care operators, the CMS rating matters for practical reasons beyond reputation.
Plans with 5-star ratings receive Quality Bonus Payments from CMS. For TIHP, that means more resources to invest in expanded member benefits, including dental, vision, transportation, podiatry, hearing, and an over-the-counter health product catalog. Plans with fewer than 4 stars can face federal scrutiny and, in persistent cases, contract termination. And 5-star plans can enroll new members any time of year, not just during standard Medicare enrollment windows.
Inside partner facilities, TIHP’s care model has produced measurable outcomes: an average 50% reduction in hospitalizations, 45% fewer ER visits, and 55% lower hospital re-admission rates among enrolled residents. Those numbers reduce disruption for residents and help facility operators manage census stability and staffing load.
What Residents and Families Say
TIHP conducts annual member surveys of a representative sample — 10% of members enrolled for 60 days or more. In 2025, 99.45% said they feel treated with courtesy and respect by their Nurse Practitioner. 97.25% said their health information is explained clearly. 93.41% said getting the care they need is easy.
That last number is worth pausing on. Long-term care residents are often navigating multiple providers, complex medication regimens, and health conditions that require consistent attention. A 93% “easy to get care” rate in that population is not typical.
“The level of professional care for our residents supersedes expectations,” said Beatrice Lozano, Social Service Director at one of TIHP’s partner facilities. “Communication has also been important to our families, especially knowing that their loved one is being taken care of — and this for me and for our team speaks volumes.”
Built in Texas, Serving Texas
TIHP is headquartered in Victoria and serves 89 counties across the state. It was built around a specific observation: traditional Medicare, as structured, was not set up to serve people living full-time in nursing facilities. Care was reactive. Problems were caught late. Hospital trips were common.
The I-SNP model was designed to change that. Keep care in the building when possible. Manage conditions before they escalate. Have someone in the facility who knows the residents by name and notices when something is off.
The 5-Star rating is based on TIHP’s 2024 performance data — and it reflects what that work actually looks like when measured.
About Texas Independence Health Plan
Texas Independence Health Plan (TIHP) is a Medicare Advantage Institutional Special Needs Plan (I-SNP) based in Victoria, Texas. The plan serves residents of nursing homes, skilled nursing facilities, and assisted living communities across 89 Texas counties, partnering with facilities to provide embedded clinical care through dedicated Nurse Practitioners and RN Care Coordinators. For the 2026 plan year, TIHP earned a CMS 5-Star rating, placing it in the top 2.5% of health plans in the United States.
Texas Independence Health Plan is a Health Maintenance Organization (HMO) Special Needs Plan (SNP) with a Medicare contract. Enrollment in Texas Independence Health Plan depends on contract renewal.