The 2026 Medicare Advantage and Part D Star Ratings, posted to Medicare Plan Finder on October 9, look calm on the surface. After several years of falling scores, litigation and recalculated cut points, the market essentially held its ground. Underneath that stability, the plans that moved did so on a small number of specific measures, and the cut point environment is tighter than the averages suggest. Because these ratings determine 2027 quality bonus payments, they deserve a closer read than the headline numbers invite.

The Headline: Stability After a Long Slide

CMS rated 516 Medicare Advantage prescription drug (MA-PD) contracts for 2026. Eighteen earned five stars, up from nine last year. About 40 percent of MA-PD contracts (207 in total) reached four stars or higher, and roughly 64 percent of MA-PD enrollees are in contracts rated four stars or above. The enrollment-weighted average overall rating rose slightly, from 3.95 to 3.98, still well below the 4.14 average of the 2023 ratings.

The distribution tells the more useful story. The largest single band is 3.5 stars, which holds roughly a third of all rated MA-PD contracts. Those contracts sit one half star below the bonus threshold, and for many of them the gap comes down to a handful of measures.

What Moved at the Measure Level

Average measure-level ratings shifted in both directions, and several of the swings are large enough to change contract outcomes on their own.

  • Gains: Colorectal Cancer Screening rose from an average of 3.4 to 3.8 stars in a year when the measure moved to electronic clinical data systems (ECDS) reporting. Controlling Blood Pressure recovered from 3.0 to 3.4, Statin Therapy for Patients with Cardiovascular Disease from 3.0 to 3.3, and Statin Use in Persons with Diabetes from 2.8 to 3.3. Medicare Plan Finder Price Accuracy jumped from 3.4 to 4.6.
  • Declines: Breast Cancer Screening fell from 3.4 to 3.2. Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions dropped from 3.2 to 2.8. Improving Bladder Control slipped from 3.0 to 2.7, Care for Older Adults Pain Assessment from 4.2 to 3.9, and Plan All-Cause Readmissions from 3.1 to 2.9.
  • Flat but heavy: The three Part D medication adherence measures were essentially unchanged, at 3.1 (diabetes), 3.3 (RAS antagonists) and 3.2 (statins). These are triple-weighted, so "unchanged" means plans spent another year without gaining ground on some of the most valuable measures in the program.

Cut Points Keep Climbing

2026 is the third year of the Tukey outlier deletion methodology, applied with guardrails that limit how far most non-survey cut points can move year over year. Industry analyses of the new thresholds found that a majority of cut points increased, with increases concentrated at the two-, three- and four-star thresholds rather than at five stars. That compresses the distance between star levels, so a contract can improve its raw performance and still hold the same star on a measure.

The follow-up after emergency department visit measure illustrates the problem. Its thresholds have risen sharply over two cycles, and its average star fell from 3.2 to 2.8 this year. Diabetes blood sugar control is another example where the guardrail held back a cut point increase that would otherwise have been considerably larger. Guardrails smooth the path; they do not stop the climb.

Methodology Changes That Shaped 2026

  • Patient experience weight halved. The weight of patient experience, complaints and access measures dropped from four to two. Contracts that relied on strong CAHPS results to carry weaker clinical performance lost some of that cushion.
  • One new measure. Kidney Health Evaluation for Patients with Diabetes entered the ratings, averaging 3.5 stars in its first year.
  • Health Outcomes Survey measures returned. Improving or Maintaining Physical Health and Improving or Maintaining Mental Health came back after specification changes, at a weight of one for 2026, rising to three beginning with the 2027 Star Ratings.

What It Means for 2027 Bonus Payments

The 2026 ratings drive 2027 payments. Contracts at four stars or above receive a 5 percent increase to their county benchmarks, doubled in qualifying counties, and the overall rating also sets the share of savings a plan retains as rebates for supplemental benefits: 70 percent at 4.5 stars or higher, 65 percent at 3.5 to 4 stars, and 50 percent below 3.5. Because the market-level distribution barely moved, aggregate bonus dollars for 2027 should look similar to 2026.

That aggregate stability hides real contract-level volatility. Dozens of contracts crossed the four-star line in each direction. For a contract that fell to 3.5 stars, the loss of the benchmark bonus flows directly into thinner 2027 benefits or margin. The 2027 bids are due in early June 2026, which means finance and product teams are pricing next year against today's ratings while measurement for the 2027 Star Ratings is already nearly complete.

The 2027 Horizon

Three developments should shape planning now. First, the two Health Outcomes Survey measures triple in weight for the 2027 ratings, which rewards plans whose care management actually changes how members feel, not just what is documented. Second, under current regulations, a health equity reward (originally named the Health Equity Index and now described by CMS as the Excellent Health Outcomes for All reward) is scheduled to replace the historical reward factor beginning with the 2027 Star Ratings, shifting the bonus toward performance for enrollees with social risk factors such as dual eligibility, low-income subsidy status and disability. Plans should model both scenarios and monitor upcoming rulemaking. Third, appeals and litigation over prior-year ratings, particularly the call center measures, continue. Recalculations have changed published results before, so treat the current ratings as provisional for contracts near a threshold.

Where Plans Should Focus: A Practical Checklist

  1. Map distance to the next half star. For every contract, identify which measures, at what performance change, would move the overall rating.
  2. Prioritize triple-weighted measures. Medication adherence, intermediate outcomes such as blood pressure and blood sugar control, readmissions and the returning Health Outcomes Survey measures carry outsized value.
  3. Finish 2025 gap closure with discipline. The 2025 measurement year is nearly closed. Make sure supplemental data, lab results and documented exclusions are captured, because a missed numerator now costs a full year.
  4. Fix transitions of care. Post-discharge and post-emergency-department follow-up depend on timely notifications and fast outreach. These measures reward workflow, not intention.
  5. Prepare for digital measurement. As more measures move to ECDS, data completeness across claims, clinical and pharmacy sources becomes a ratings issue rather than an IT issue.
  6. Model the reward factor change. Understand how your contracts would perform under a health equity reward versus the current reward factor before 2027 bids are finalized next June.

How a Platform Approach Helps

Star performance improves when gap information reaches the people who can act on it, at the moment they can act. Curitics brings HEDIS gap tracking and closure into the same workflow as point-of-care encounters, where the Encounter Builder surfaces open quality gaps during the visit, and pairs it with medication reconciliation that consolidates pharmacy fills and with AI-assisted care plans that keep follow-up tied to each member's specific risks.

With cut points still rising and weights shifting toward outcomes, the window to influence the 2027 and 2028 ratings is now, not next October.