2027 CMS Final Rule: What’s changing in Star Ratings and next steps for success

The recently released 2027 Medicare Advantage (MA) and Part D Final Rule confirms changes that many MA quality leaders were anticipating: the pace of change in the Star Ratings program is not slowing down. For those keeping track of the recent proposed rule and Advance Notice, there were few surprises in the rule itself, but the cumulative impact of these changes may materially alter how plans must manage risk, performance volatility, and year-round execution moving forward.

From the retirement of operational measures to a growing emphasis on outcomes, behavioral health, and digital measurement, CMS appears to be placing greater emphasis on where and how plans are expected to compete, while simultaneously reducing the margin for error historically created by consistently high-performing administrative measures.

Figure 1. Weighted category contribution towards overall Star Rating, Star Years 2025-2029.

Figure 1 illustrates how the overall composition of the Star Ratings program is changing over time, showing the weighted contribution of each category from the 2025–2029 Star Ratings or Measurement Years (MY) 2023–2027. As operational measures are retired, the remaining categories take on a larger share of the overall rating, which likely increases both the upside and downside of performance changes and leaves plans with less margin for error.

MY 2025: Fewer measures, higher stakes

For MY 2025, CMS largely finalized what was outlined in the Advance Notice, providing additional clarity for plans already modeling these changes. While CMS indicated it expects minimal disruption overall, these updates are now fully codified and should be reflected not only in performance and financial planning, but also in incentive design and enterprise-wide priorities.

Key takeaways include:

• CMS made no additional updates beyond what was proposed, aligning with assumptions many plans had already incorporated.
• COA Pain Assessment and standalone Medication Reconciliation Post Discharge are removed from Star Ratings. Colorectal Cancer Screening expands to ages 45 to 49, though the expanded age group is excluded from improvement calculations for the year.
• COA Functional Status Assessment, Concurrent Use of Opioids and Benzodiazepines, and Polypharmacy enter the program at a weight of one. A statin intolerance exclusion is added to Statin Therapy for Patients with Cardiovascular Disease.
• Improving or Maintaining Physical Health and Improving or Maintaining Mental Health increase in weight after reentering the program last year, reinforcing CMS’s focus on outcome-based performance.
• The Medication Therapy Management Program Completion Rate moves to the display page and may return following re‑specification. Diabetes Care Eye Exam no longer allows hybrid reporting but remains part of Star Ratings.
• CMS confirmed it will not implement the Health Equity Index or EHO4all reward and will continue using the historical reward factor, emphasizing broad improvement in clinical outcomes and member experience while reinforcing the importance of prior health equity investments.

MY 2026: The shift accelerates

MY 2026 represents a clear inflection point, particularly for pharmacy and operational measures. Key takeaways include:

• Traditional medication adherence is retired and replaced with risk adjusted medication adherence, entering the program at a weight of one. Risk adjustment introduces greater score dispersion, increasing both upside opportunity and downside risk across contracts.
• CMS did not finalize Opioid Prescribing for Long Duration or Initiation and Engagement of Substance Use Disorder Treatment. With the measurement year already underway and no timing updates provided, these additions appear unlikely for MY 2026.
• Statin Therapy for Patients with Cardiovascular Disease is removed following substantive NCQA updates, and is expected to spend approximately two years on the display page before returning to the program.
• CMS finalized the retirement of call center TTY measures, citing consistently high performance and limited variation across plans.

MY 2027: Reshaping the program

Starting in MY 2027, several major changes reshape the program, including:

• Risk-adjusted medication adherence measures increase to a weight of three, reinforcing its central role in overall performance.
• Breast Cancer Screening enters Star Ratings after completing two years on the display page, following codification of the expanded eligible age range.
• Depression Screening and Follow Up is added at a weight of one, representing one of the first Star Ratings measures focused explicitly on behavioral health and elevating the importance of data completeness, coding accuracy, and timely follow-up.
• The Medication Therapy Management Program Completion Rate and SNP‑specific measures remain deferred, with CMS signaling they could return after time on the display page or be retired altogether.
• CMS finalized the retirement of most remaining operational measures proposed in late 2025, with Diabetes Care Eye Exam being the sole exception. While retired measures will continue to be monitored and publicly reported, their removal from scoring eliminates a key source of historical rating stability and increases overall Star volatility.

MY 2028 and beyond

Looking ahead, CMS acknowledged several items still in transition. Proposed removals of Transitions of Care and Plan All-Cause Readmissions were not finalized, leaving timing unclear. If revisited, these measures would likely follow the standard pathway of moving to the display page before potentially returning.

More broadly, these changes align with the continued transition from traditional measures to Electronic Clinical Data Systems (ECDS). While timelines are not fully confirmed for all measures, plans should expect traditional and digital measures to coexist until ECDS versions are fully ready for inclusion.

Bringing excellence home

As Star Ratings continue to shift toward outcomes, excellence must move beyond strategy and be embedded into everyday execution. MA plans should elevate member experience as a year-round priority, recognizing that roughly one‑third of Star Ratings performance reflects how members perceive and experience care, while also strengthening outcome‑driven clinical performance, as HEDIS^® and pharmacy measures approach nearly half of the overall calculation by MY 2029.

Below are some next steps for consideration over the short and long term.

Success in this environment typically requires clear visibility into performance, including the ability to distinguish data gaps from care gaps, help ensure behavioral health data completeness, and prepare for digital and ECDS measurement. Because clinical quality and member experience together represent over half of overall Star Ratings performance, plans that act deliberately now may be able to meaningfully improve performance while managing risk and avoiding additional operational complexity.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance.