As the 2025 calendar year closes out, Medicare Advantage (MA) leaders are continuing to evaluate the potential impact of a proposed rule released by the Centers for Medicare & Medicaid Services (CMS) that would significantly reshape the MA and Part D Star Ratings program. Here, we break down the most impactful changes, evaluate how they would impact overall Star Ratings outcomes, and offer recommendations for MA plan leaders to consider in their 2026 and 2027 strategies.
Summary of key Star Ratings changes proposed
According to the administration, these changes aim to simplify the program; strengthen competition; reduce administrative burden; and sharpen the focus on clinical care, outcomes, and patient experience. Key proposals include:
Removal of the Health Equity Index (EHO4all) reward
CMS proposes not to implement the HEI reward—recently renamed to EHO4all—with the 2027 Star Ratings. Instead, the agency would continue using the historical reward factor. This marks a strategic shift away from incentivizing improvement among specific populations toward rewarding overall performance in clinical care, outcomes, and member experience.
Retirement of low-variation measures
The proposed rule would retire more than a dozen measures deemed administrative or showing little performance variation across contracts. These include metrics such as Call Center – Foreign Language Interpreter and TTY Availability, Complaints about the Health Plan, Customer Service, and Plan Makes Timely Decisions about Appeals. Several clinical measures, such as Diabetes Care – Eye Exam and Statin Therapy for Patients with Cardiovascular Disease, would also move to the display page rather than factor into Star Ratings.
Addition of new behavioral health measure
To address gaps in behavioral health, CMS proposes adding a new measure: Depression Screening and Follow-Up. This measure, aligned with the Universal Foundation, would enter the Star Ratings in the 2027 Measurement Year (2029 Star Ratings).
Impact on Star Ratings scores
According to Cotiviti’s analysis, most contracts (62%) would see no change in overall rating under the proposal. However, 13% could gain a half star, while 25% might lose a half star, and one contract could drop by a full star. Quality bonus payments would shift slightly, with 5% of contracts gaining and 4% losing eligibility. While retiring high-performing measures may lower ratings overall, CMS expects the removal of the EHO4all reward to generally increase ratings for many plans.
The proposed changes also alter category weights significantly. By the 2029 Star Ratings, CAHPS and HOS survey measures will account for 36% of a contract’s overall rating, HEDIS® and pharmacy measures will represent 48%, and improvement measures will rise to 16%. Operational measures, which currently make up 21%, will drop to zero.
|
Measure category |
SY 2027 |
SY 2028 |
SY 2029 |
|---|---|---|---|
|
CAHPS |
20% |
23% |
21% |
|
HEDIS |
22% |
24% |
29% |
|
HOS |
11% |
12% |
15% |
|
Improvement |
12% |
14% |
16% |
|
Operations |
21% |
19% |
0% |
Figure 1. How measure category weights would shift under the proposed rule.
Three recommendations for MA plan leaders
Amid this potential overhaul and further changes to come in the 2027 Advance Notice and Final Rule, MA plan leaders have a difficult task ahead as they determine where to invest their quality improvement resources. Consider the following strategies as we enter the 2026 Measurement Year:
- Double down on clinical performance. With operational measures potentially disappearing and clinical outcomes gaining weight, plans must strengthen gap closure strategies for high-impact HEDIS and pharmacy measures. Deploy predictive analytics to identify members at risk of non-compliance and implement targeted outreach for medication adherence and chronic condition management.
- Continue to elevate the member experience. Under these proposed changes, CAHPS and HOS would represent more than a third of overall scores by the 2029 Star Ratings. Build on investments that have already been made for EHO4all incentive by improving the member experience through tactics such as streamlining call center operations, enhancing digital self-service, and creating rapid-response teams to resolve member issues. Improving trust and access will be critical to maintaining competitive ratings.
- Prepare for behavioral health integration. The potential addition of Depression Screening and Follow-Up signals CMS’s commitment to behavioral health. Plans should embed screening protocols in primary care workflows, ensure timely follow-up, and integrate data capture into existing reporting systems. Early readiness will prevent last-minute compliance challenges.
CMS’s proposed overhaul signals a clear direction: fewer administrative measures, greater weight on clinical outcomes and member experience, and removal of equity-specific rewards. Plans that act now to strengthen quality and experience will be best positioned for success in future Star Ratings cycles.
eBook: Achieving Star Ratings success in the ECDS era
With this proposed rule and other challenges such as rising cut point thresholds, tougher scoring methodologies, and shifting measure weights, plans that don’t have a firm digital data strategy in place risk falling behind in improving both quality scores and member health.
Read Cotiviti’s new eBook as we break down:
- How hybrid measures are rapidly disappearing
- Which triple-weighted measures are at risk
- The fundamentals of a year-round digital data strategy
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
