2027 Star Ratings: What Changed and What It Means for MA Plans

CMS posted the 2027 Medicare Advantage Star Ratings on October 8, and if you only read the headline, it looks like a quiet year. The enrollment-weighted average for MA-PD contracts (Medicare Advantage plans with drug coverage, which is how CMS reports overall ratings) dipped from 4.01 to 3.99, and about 71% of those enrollees are in a contract rated 4 stars or higher, up from roughly 67% last year.

The contract-level view is where it gets interesting. Only 188 of 508 MA-PD contracts reached 4 stars this year, compared with 229 of 516 a year ago, so the quality bonus is landing on fewer, larger plans. Five-star contracts dropped from 22 to 15 and on several of the screening measures plans have worked hardest on, the average star went down even as screening went up. NCQA's latest Health Plan Ratings showed kidney health screening in MA up 7.3 percentage points, yet the average star on that measure fell from 3.5 to 3.2.

These ratings set 2028 quality bonus payments, so that gap between doing better and scoring better deserves a bit of a second look. Here's what changed, which measures moved, and what it means for the next two measurement years.

What changed in the 2027 Star Ratings methodology

The measure set shifted more than the average suggests. MA-PD contracts were rated on up to 43 measures this year, and a handful of changes in the 2027 Star Ratings measures and weights moved where the points come from:

• Member-reported health now counts triple. Improving or Maintaining Physical Health and Improving or Maintaining Mental Health went from a weight of 1 to 3 after CMS updated how they're measured.
• Colorectal Cancer Screening was respecified and entered the ratings as a new measure with a weight of 1, replacing the legacy version.
• Part D added two safety measures: Concurrent Use of Opioids and Benzodiazepines, and Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults.
• Some measures left or returned. Pain Assessment and Medication Reconciliation Post-Discharge were retired, the MTM completion rate moved to the display page until 2029, and Functional Status Assessment came back after a specification change.

What didn't change is just as important. CMS isn't implementing the Excellent Health Outcomes for All reward (formerly the Health Equity Index reward) and is keeping the historical reward factor instead. Cut points are still recalculated every year using Tukey outlier deletion, which means a plan can raise its rate on a measure and still lose a star if the rest of the market improved faster.

Which measures went up and which went down

Preventive screening and chronic condition management took the biggest hits this year, while care transitions had a strong cycle. The averages below are the mean star score across MA contracts for each Part C measure, from the CMS 2027 Star Ratings fact sheet, with the declines listed first.

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The readmissions jump is real progress on a triple-weighted outcome measure, but the losses weigh more overall. Controlling Blood Pressure fell 0.4 stars and also counts three times, and Physical Health slipped in the same year its weight tripled. Colorectal screening comes with a caveat, since it was respecified and treated as a new measure, so 2026 and 2027 aren't a perfect comparison. Even so, plans that averaged close to 4 stars on it a year ago now sit at 3.4.

The contract-level data in CMS's 2027 Star Ratings data tables makes the pressure easier to see. Among rated MA-PD contracts, 63% landed below 4 stars on Kidney Health Evaluation and 70% on Controlling Blood Pressure. The median contract completed KED for 68% of eligible members, four points short of the 72% it took to earn 4 stars. Colorectal screening sat right on the edge, with a median rate of 75%, exactly the 4-star cut point.

These measures also separate the plans that made 4 stars from the ones that didn't. Contracts rated 4 stars or higher overall averaged 4.3 stars on colorectal screening, compared with 3.4 for contracts stuck at 3.5. The same pattern held on KED (3.8 vs. 3.0) and blood pressure (3.7 vs. 3.0).

On the Part D side, Medication Adherence for Diabetes Medications slid from 3.1 to 2.7 for MA-PD contracts, while adherence for hypertension and cholesterol medications each improved by 0.1 – a small, but important increase. 

How the top of the market shifted

The leaderboard reshuffled this year, with big swings in both directions. Only 15 MA-PD contracts earned 5 stars, and just six of them also held 5 stars in 2026. This year's group is a real mix of national carriers, regional plans, and smaller organizations, which is a reminder that size alone doesn't buy a top rating. A few large national carriers posted major rebounds and moved most of their members back into 4-star plans. Others watched a flagship contract slip under the 4-star line, taking a big share of their membership with it.

There's also a legal backdrop. After a court sided with Clover Health this summer, CMS recalculated some 2026 scores and appealed the decision, and other plans have filed similar suits. Expect more appeals this cycle.

For everyone else, the stakes are easy to state. When a single large contract crosses the 4-star line in either direction, analyst estimates cited by Healthcare Dive put the swing in 2028 revenue anywhere from about $170 million to more than $3 billion. Those crossings tend to come down to a few tenths of a star on a few measures.

Why do nonprofit plans keep outperforming?

When going through the data, there’s a trend that’s hard to ignore. About 44% of nonprofit MA-PD contracts earned 4 stars or more this year, compared with about 34% of for-profit contracts. CMS doesn't explain the gap and the data can't prove a cause, but our read is that a lot of it comes down to trust.

Many nonprofit plans are tied to a local health system or have served the same community for decades, and CMS's data hints at the tenure piece: about 42% of contracts in the program for 10 or more years reached 4 stars, compared with roughly 30% of contracts under 10 years. When members already know and trust the name on the envelope, they're more likely to open it, finish the screening, answer the survey, and stay. All of that feeds the rating. Plans of any tax status can take something from that, because the member's relationship with your brand is a quality lever in its own right.

What the 2027 Star Ratings mean for plans moving forward

Clinical measures are about to carry more of the rating, and the bar on those measures keeps rising. Holding or gaining stars from here will depend on reaching the members your current outreach isn't reaching.

The measure set is narrowing toward clinical care

Under the CY 2027 final rule, CMS is removing 11 measures focused on administrative processes. Call Center Interpreter and TTY Availability and Statin Therapy for Patients with Cardiovascular Disease drop out with the 2028 Star Ratings, and most of the rest, including appeals, complaints, and Members Choosing to Leave the Plan, leave with the 2029 ratings, according to Rise Health. CMS is also adding a Depression Screening and Follow-Up measure for 2029.

Plans tended to score well on those departing measures (call center access averaged 4.4 stars this year), so their exit leaves HEDIS clinical measures holding a bigger share of every overall rating. There's less room to make up for a weak screening program somewhere else.

Screening has turned into a treadmill

Because cut points are set against the rest of the market, a better rate only helps if it beats where everyone else landed. That's how kidney health screening can climb across MA while the average star on it falls - it also means a lot of plans are close. In this year's data, nearly half of the MA-PD contracts that fell short of 4 stars on Blood Sugar Controlled were within 3 percentage points of the line, and about a third of those below it on blood pressure were too.

The tricky part is who's left in those gaps. Most plans have already screened the members who open the mail and pick up the phone and now the open gaps belong to members who have ignored the usual letters and calls, often for a reason, and sending them another round of the same thing rarely changes the outcome. Moving them usually takes a different experience: how the test gets to them, who it seems to come from, and how easy it is to finish.

The clock on 2028 is already running

The 2028 Star Ratings will draw largely on measurement year 2026, which ends in fewer than 12 weeks. Any member who hasn't completed a colorectal screening, kidney health evaluation, or A1c test by December 31 is a gap that stays open on next year's report. Plans that kick off 2027 outreach in January instead of the fall give themselves a full year of runway for 2029.

Where at-home testing fits

Several of the measures that slipped this year can be closed with a kit sent to the member's door:

• Colorectal Cancer Screening. A FIT kit counts toward the measure, and mailing kits works. The Community Preventive Services Task Force found that reducing structural barriers to screening, such as mailing stool test kits, raised screening by a median of 16.1 percentage points. In one CDC-published trial, mailed FIT outreach lifted kit return from 6.4% to 16.9%.
• Kidney Health Evaluation. KED needs both an eGFR and a urine albumin-creatinine ratio (uACR), and the uACR is usually what's missing. A National Kidney Foundation and Manatt Health analysis found fewer than three in ten MA enrollees received both tests in 2023, with uACR testing well behind eGFR.
• Blood Sugar Controlled and Controlling Blood Pressure. Both count three times. An at-home A1c result can close the diabetes gap and gives care teams something to act on. Blood pressure control depends on ongoing clinical follow-up, so the value there comes from getting results back to the member's PCP.

None of this replaces the provider relationship. It fills in around it and reaches members who aren't going to book a visit for a single test.

Test, measure, and change what isn't working

If outreach on a measure has flatlined, running the same playbook harder probably won't move it. Change one variable at a time, whether that's the channel, the timing, the language, or how the test reaches the member, and try it with one segment before you scale. It's also worth asking what you should build in-house at all. Outreach, kit logistics, lab capacity, and getting results back into the gap file are a lot to stand up, and many plans get more from putting their own team on what no outside partner can do, which is knowing their members. With cut points resetting every year, standing still is a slow way to lose ground.

Plan for 2029 now

The 2027 results are locked and the 2028 ratings are mostly set. What plans do over the next few months shapes 2029, when clinical measures will carry even more of the weight.

Ash works with health plans to close HEDIS gaps through at-home kits for measures like colorectal cancer screening, kidney health evaluation, and A1c, all delivered under your plan's brand. See how our gap closure programs work for Medicare Advantage plans, or reach out to our team to talk through your 2027 outreach plan.

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