2027 Medicare Star Ratings: what changed

The CY2027 Medicare Advantage final rule dropped the planned health equity reward and kept the historical reward factor. It removed 11 measures, mostly administrative and survey items, and added a depression screening measure for 2029 Stars. Separately, under a 2023 rule, Part D adherence measures drop to weight 1 for 2028 Stars before returning to 3.

Why Star Ratings matter in dollars

Star Ratings score Medicare Advantage (MA) and Part D plans from 1 to 5 stars. Plans rated 4 stars or higher get quality bonus payments (QBP). See our Star Ratings glossary entry.

KFF estimates Medicare will spend at least $13.4 billion on quality bonuses in 2026. About 68% of MA enrollees, nearly 24 million people, are in bonus-eligible plans.

CMS announced the final rule April 2, 2026. It was published April 6 and took effect June 1, 2026.

Health equity reward dropped, reward factor kept

CMS had planned a Health Equity Index (HEI), later renamed Excellent Health Outcomes for All (EHO4All). It would have replaced the reward factor with a bonus tied to how plans performed for members with social risk factors.

The final rule doesn't implement it. CMS keeps the historical reward factor, which rewards plans whose performance is both high and consistent across measures.

If you built a plan strategy around the HEI, set it aside. The goal is consistent high performance across the measures that count.

The measures CMS removed

CMS removed 11 measures, including these:

From the 2028 Star Ratings:

• Call Center: Foreign Language Interpreter and TTY Availability (Parts C and D)
• Statin Therapy for Patients with Cardiovascular Disease (Part C)

From the 2029 Star Ratings (2027 measurement period):

• Plan Makes Timely Decisions about Appeals (Part C)
• Reviewing Appeals Decisions (Part C)
• Special Needs Plan (SNP) Care Management (Part C)
• Complaints about the Health or Drug Plan (Parts C and D)
• Medicare Plan Finder Price Accuracy (Part D)
• Members Choosing to Leave the Plan (Parts C and D)
• Customer Service (Part C)
• Rating of Health Care Quality (Part C)

Kept: CMS proposed removing Diabetes Care: Eye Exam but kept it. Providers should keep closing that gap.

Removed outside this rule for 2027 Stars: Care for Older Adults Pain Assessment, Medication Reconciliation Post-Discharge, and MTM Completion Rate for Comprehensive Medication Review (CMR).

CMR goes display-only. The CMR measure is on the 2027 display page. CMS says it returns "as a new measure beginning with the 2029 Star Ratings." Pharmacies running MTM (medication therapy management) should keep doing CMRs. The measure is coming back. See our CMR glossary entry.

What the removals mean for the score

The overall rating is a weighted average. Take measures out and each remaining measure carries a bigger share. Most removals are customer service, appeals, complaints and survey items. That shifts the balance toward clinical measures and Part D adherence.

For plans, call center polish buys less than it used to. For the provider groups and pharmacies plans work with, the measures you directly affect now matter more. These include blood pressure control, diabetes control, eye exams and adherence. Expect plans to push those harder in 2027 contracts and incentive programs.

What was added

Depression Screening and Follow-Up (Part C) is new. It's measured starting in 2027 and first counts in the 2029 Star Ratings. New measures carry weight 1 in their first year.

For provider groups, this is a measure you can act on now. The 2027 measurement year starts January 1.

How the weights are shifting

Weights decide how much each measure moves the overall rating. Under 42 CFR 422.166(e):

• Outcome and intermediate-outcome measures: weight 3
• Process measures: weight 1
• New measures: weight 1 in their first year

Patient experience, complaints and access measures dropped from weight 4 to 2, starting with the 2026 Star Ratings. These include the CAHPS member survey measures. Combined with the removals above, survey and administrative measures carry less of the score.

Part D adherence covers 3 measures: diabetes medications, RAS antagonists (blood pressure drugs) and statins. Each is weighted 3 in the 2027 Star Ratings. A sociodemographic status (SDS) risk adjustment applies starting with the 2028 Star Ratings. CMS finalized it in 2023. Because CMS treats that as a substantive change, the weights work like this:

Don't ease off adherence. Star Ratings lag performance by about two years: the 2029 Stars draw on the 2027 measurement period. So the fills your patients pick up next year count at weight 3 again.

What provider groups should prioritize

Plans pass Star Ratings pressure to the groups they contract with. Focus here:

1. Clinical outcome measures. Blood pressure control and diabetes control carry weight 3 and still count.
2. Diabetes eye exams. CMS kept the measure. Track it on your gap list.
3. Depression screening. Build it into visits now for the 2027 measurement year.
4. Annual wellness visits. The AWV is where many gaps get found and closed. Our AWV billing guide covers the codes.

What pharmacies should prioritize

1. Adherence, every month. Proportion of days covered (PDC) at 80% or higher is the target. Our PDC improvement guide has the details.
2. Keep doing CMRs. The measure returns in 2029 Stars.
3. Statin use. Statin Therapy for Patients with CVD is out of Stars for 2028, but statin adherence still counts.

The work behind both lists is the same: reach the patient, find the barrier, fix it or route it. Southeast Medical Group used Rivvi to reach 104,000+ patients. One pharmacist reached 30,000 patients, versus about 200 manually. Refill success was 56%, versus 5-10% with manual outreach (August 2026).

Rivvi's free workspace lets you upload a plan's gap or adherence report and ask which patients to call first. On the Team plan, Rivvi calls and texts those patients. It warm-transfers anything clinical to a person, or creates a task. See how Rivvi supports Star Ratings and medication adherence work.

Sources

• CMS: Contract Year 2027 Medicare Advantage and Part D Final Rule Fact Sheet (Apr 2, 2026)
• Federal Register: CY2027 MA and Part D Final Rule (Apr 6, 2026)
• Wakely: Summary of 2027 Final Rule Star Ratings Changes
• Crowell: CMS Finalizes CY2027 Medicare Advantage and Part D Rule
• eCFR: 42 CFR 422.166, Calculation of Star Ratings
• Federal Register: CY2024 MA and Part D Final Rule (Apr 12, 2023)
• RISE: Star Ratings Measure Set Shrinks
• CMS: 2027 Star Ratings Measures
• KFF: Medicare Will Spend More Than $13 Billion on the MA Quality Bonus Program in 2026
• CMS: 2026 Star Ratings Fact Sheet
• PQA: Measures Resources