Medicare Advantage Star Ratings with the 2027 Final Rule: Key Takeaways
CMS just reset the Medicare Advantage Star Ratings with the 2027 Final Rule, and the message is clear: the easy points are gone.
CMS has been planning to simplify the Part C and D Star Ratings through reducing the number of measures and focusing the measure set on clinical care, outcomes, and patient experience. The 2027 Final Rule solidifies this strategy with multiple upcoming changes.
This, however, means that the margin for success grows slimmer yet. By purging multiple process measures, CMS has removed the safety net that allowed plans to mask clinical underperformance.
Stays
- The Part C Diabetes Care: Eye Exam measure had been considered for removal, but based on comments received by CMS, this measure has been retained for now.
Shifts
- For the Part C Statin Therapy for Patients with Cardiovascular Disease (SPC) measure, CMS confirms that this measure will be on the display page starting in 2028 due to the substantive change to the age qualifications. Its potential return to the Star Ratings or removal from the Ratings altogether is also hanging in the balance.
- Ten (10) additional measures are gone for good, including call center, appeals, and customer service measures.
- The historical reward factor will continue to be used, meaning that the Health Equity Index (HEI) reward, also known as the Excellent Health Outcomes for All (EHO4all) reward, from the 2024 Final Rule will not be implemented for 2027. CMS remains focused on incentivizing clinical care, outcomes, and patient experience across the full population versus select population subsets.
- One new Part C measure, Depression Screening and Follow-Up, will be added to the 2029 Star Ratings. It was also previously announced that the MTM Program Completion Rate for CMR will be returning to the 2029 Star Ratings. This means that Measurement Year 2027 will be critical for creating impact.
Implications for Health Plans
This isn’t just a change in math; it’s a change in operational philosophy. The advantage no longer comes from documentation alone; it comes from the ability to execute care models that reliably close gaps at the point of care. Success now favors organizations that can:
- Engage Patients in the Home: Driving adherence where it actually happens.
- Scale Clinical Interventions: Operationalizing CMRs and safety screenings at a population level.
- Bridge the Gap: Integrating pharmacy expertise directly into the quality workflow.
The Stars program just became simpler to understand, but much harder to execute. The winners will be those who translate patient touchpoints into outcomes, not just paperwork. Read the complete final rule here.