CMS has announced a comprehensive overhaul of the Medicare Advantage Star Rating system that will shift weight toward patient outcome metrics rather than process measures, potentially reshuffling plan rankings affecting 30 million enrollees.
Key Changes
The revised methodology introduces three major modifications to how plans are evaluated starting with the 2027 plan year.
- Patient-reported outcome measures will account for 35% of the total score, up from 15%
- Health equity measures added: plans serving diverse populations get bonus points for reducing disparities
- Prescription drug pricing transparency now factored into pharmacy quality metrics
- Mental health access scores weighted equally with physical health for the first time
Impact on Enrollees
Plans that currently hold 4+ star ratings could see significant shifts. UnitedHealthcare and Humana, which together cover 45% of MA enrollees, have lobbied against the changes, arguing the timeline is too aggressive. Consumer advocates counter that the current system rewards administrative efficiency over actual health improvements.
