CMS published the 2027 Medicare Advantage and Part D Star Ratings on October 8, just ahead of open enrollment. At first glance the results look steady: the enrollment-weighted average overall rating for MA prescription drug (MA-PD) contracts is 3.99, compared with 4.01 for 2026 and 3.95 for 2025. Look one layer down, though, and the picture is more uneven. Fewer contracts reached the top tiers, more enrollees are concentrated in highly rated plans, and the rules governing the next several cycles have shifted in ways that will reward some strategies and punish others. These ratings determine 2028 quality bonus payments, so the financial consequences are already locked in for many plans.

The Headline Results

  • Fewer four-star contracts. About 37% of MA-PD contracts (188 of 508 rated) earned four stars or higher, down from roughly 44% of contracts for 2026.
  • More enrollees in four-star plans. Weighted by enrollment, about 71% of MA-PD enrollees are in contracts rated four stars or higher for 2027, up from roughly two-thirds for 2026. The divergence suggests that many of the largest contracts held or improved their ratings while smaller contracts slipped.
  • Fewer five-star contracts. Fifteen MA-PD contracts earned five stars, down from 22.
  • A heavier middle. The share of contracts at three stars rose noticeably, and the share at four and a half stars fell.
  • Standalone Part D improved. About 22% of standalone prescription drug plan enrollees are in contracts with four or more stars for 2027, compared with about 2% for 2026.

For plans that slipped below four stars, the impact is material: losing the quality bonus reduces benchmark payments and rebate dollars, which flows directly into 2028 benefit design and competitiveness.

What Changed in the Measures

Several methodology changes, finalized in earlier rulemaking, took effect with the 2027 ratings.

  • New measures: Concurrent Use of Opioids and Benzodiazepines and Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults joined the Part D side.
  • Returning and respecified measures: Care for Older Adults: Functional Status Assessment returned after specification changes, and a respecified Colorectal Cancer Screening measure replaced the legacy version.
  • Heavier outcome weight: The Health Outcomes Survey measures Improving or Maintaining Physical Health and Improving or Maintaining Mental Health increased from a weight of one to a weight of three after a substantive specification change.
  • Retired measures: Care for Older Adults: Pain Assessment and Medication Reconciliation Post-Discharge left the ratings. The Medication Therapy Management completion rate for comprehensive medication reviews remains on the display page and returns to the ratings for 2029.
  • Data integrity: CMS used Part C reporting data to confirm the completeness of appeals data and applied scaled reductions where it identified integrity issues.

The tripling of the Health Outcomes Survey measures deserves particular attention. These measures depend on how members report their own physical and mental health over time, which plans cannot influence through documentation or data submission. They reward sustained care management, functional support and behavioral health access.

The Rule Changes Shaping the Next Cycles

The CY 2027 Medicare Advantage and Part D final rule, issued in April, made three changes every Stars leader should have on the planning calendar.

The Health Equity Index Reward Was Not Implemented

CMS had planned to replace the historical reward factor with the Health Equity Index reward (renamed Excellent Health Outcomes for All) beginning with the 2027 ratings. The final rule did not implement it and kept the historical reward factor, which rewards consistently high performance across all measures for all enrollees. Plans that built strategies around performance for members with social risk factors still benefit clinically from that work, but the specific Star Ratings reward no longer applies. The reward factor favors broad, consistent excellence over targeted gains.

Eleven Measures Are Being Removed

CMS finalized the removal of 11 measures focused on administrative processes or showing little variation among plans. The Call Center: Foreign Language Interpreter and TTY Availability measures and Statin Therapy for Patients With Cardiovascular Disease are removed beginning with the 2028 ratings. The remaining removals, including the Part C appeals measures, take effect with the 2029 ratings. CMS did not finalize its proposal to remove the diabetes eye exam measure.

As administrative measures drop away, the remaining weight concentrates on clinical care, medication management, member experience and outcomes. Plans that relied on reliable points from operational measures will need to find them elsewhere.

A Behavioral Health Measure Is Coming

A new Part C Depression Screening and Follow-Up measure begins with measurement year 2027 and first appears in the 2029 ratings. That means the data capture that determines performance starts in less than three months. Screening must be recorded with a validated instrument and coded result, and positive screens need documented follow-up.

Lessons for the Next Cycle

  1. Treat the middle as at risk. With more contracts clustering at three and three and a half stars, small measure-level differences determine whether a plan reaches the bonus threshold.
  2. Invest in outcomes, not just process. Triple-weighted Health Outcomes Survey measures reward care management and functional support that take more than one year to show results.
  3. Build digital-ready quality data. Respecified measures like colorectal cancer screening depend on electronic clinical data. Structured capture at the point of care matters more each year.
  4. Plan for the depression measure now. Standardize screening tools and follow-up workflows across the network before January.
  5. Aim for consistency across all measures. The historical reward factor rewards plans that perform well everywhere, not just on a handful of measures.
  6. Protect data integrity. CMS is checking the completeness of submitted data and applying reductions when it falls short.

Turning Lessons Into Workflow

Many of these lessons come down to closing gaps during the visit and keeping data clean. Curitics supports health plans and their provider partners with HEDIS gap tracking and closure, an Encounter Builder that captures validated screenings, vitals and quality-gap closure as structured data during the visit, and AI-assisted care plan drafting for care management programs aimed at sustained outcomes.

The 2027 ratings will be remembered less for the slight dip in the average than for what they revealed: a market sorting itself into plans that perform consistently across every domain and plans still relying on a few strong measures. The rule changes ahead will widen that gap.