The 2027 Medicare Advantage Star Ratings Are Out. New Drug Safety Measures Will Reach Your Prescribing.
CMS published the 2027 Star Ratings on Oct. 8: 37 percent of drug-plan contracts earned four stars or more, down from 44 percent. New opioid-benzodiazepine and anticholinergic measures and triple-weighted outcome measures will shape plan outreach to practices.
Idea in Brief
The News
CMS published the 2027 Medicare Advantage and Part D Star Ratings on Oct. 8, days before open enrollment begins Oct. 15. Fewer contracts reached four stars, and five-star contracts fell from 22 to 15.
What Changes
Two claims-based Part D measures are new, colorectal screening was respecified to ages 45 to 75, and two patient-reported outcome measures now carry triple weight.
Why It Matters
Plans have bonus money riding on measures that depend on prescribing and documentation, so expect gap lists and medication safety outreach. Check them against the chart.
On Oct. 8, the Centers for Medicare and Medicaid Services published the 2027 Medicare Advantage and Part D Star Ratings on Medicare Plan Finder. Open enrollment runs Oct. 15 through Dec. 7, so patients will see the ratings beside premiums and benefits as they choose 2027 coverage.
The ratings also drive 2028 quality bonus payments, and KFF estimated that bonus spending will total at least $13.4 billion in 2026. This year the yardstick changed: two new drug safety measures, a respecified colorectal screening measure and triple weight for two patient-reported outcome measures. Those changes explain much of what plans will ask of practices.
What CMS reported
About 37 percent of Medicare Advantage contracts with drug coverage, 188 of 508 rated, earned four stars or higher, down from 44 percent last year, according to CMS. Weighted by enrollment, about 71 percent of those enrollees are in a contract rated four stars or higher. Fifteen contracts hold five stars, down from 22, and the enrollment-weighted average rating slipped to 3.99 from 4.01. Four contracts carry the low-performing icon, the same number as last year.
Healthcare Dive reported that CMS raised many measure thresholds this year. In its analysis, 93 percent of Humana members will be in plans rated four stars or higher in 2027, and a TD Cowen analyst estimated the gain could be worth $3 billion or more in 2028 revenue. Alignment Healthcare moved the other way: only 25 percent of its members will be in plans above four stars, down from 98 percent. The company said it intends to pursue all available administrative remedies, and STAT reported that Alignment has threatened to sue.
The ratings describe contracts, not clinics, and they moved in part because the yardstick moved. Several of the new measures turn on prescribing and documentation in your office.
What changed in the measures
Two Part D measures are new, each at weight 1: Concurrent Use of Opioids and Benzodiazepines, and Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults. Per the 2027 Technical Notes, both are scored from Prescription Drug Event claims for 2025. The first counts patients 18 and older on opioids who also had at least 30 cumulative days of overlapping opioid and benzodiazepine supply. The second counts patients 65 and older with at least 30 cumulative days of overlap between two or more different anticholinergic drugs. Lower rates earn more stars; the average rates among drug-plan contracts were 13 percent and 9 percent.
The respecified colorectal cancer screening measure (HEDIS COL-E) replaces the legacy version at weight 1 and covers enrollees 45 to 75. The Improving or Maintaining Physical Health and Mental Health measures rose from weight 1 to weight 3; they come from the Health Outcomes Survey of sampled enrollees 65 and older, not from claims. Care for Older Adults pain assessment and Medication Reconciliation Post-Discharge were retired, and the functional status assessment measure returned for Special Needs Plans only.
Several office-dependent measures also slipped in CMS's table of average measure scores. Controlling Blood Pressure fell from 3.4 to 3.0 stars and the diabetes eye exam from 3.4 to 3.2. Colorectal screening fell from 3.8 to 3.4, though the respecified measure is not a like-for-like comparison.
Clinical Pearls
- About 37 percent of Medicare Advantage drug-plan contracts, 188 of 508, earned four stars or higher for 2027, down from 44 percent.
- About 71 percent of MA-PD enrollees are in contracts rated four stars or higher, and the enrollment-weighted average fell to 3.99 from 4.01.
- Concurrent opioid and benzodiazepine use counts at least 30 cumulative days of overlapping supply among Part D enrollees 18 and older who use opioids.
- The anticholinergic polypharmacy measure counts enrollees 65 and older with at least 30 days of overlap between two or more different anticholinergics.
- The respecified colorectal cancer screening measure covers enrollees 45 to 75 and replaces the legacy measure at weight 1.
- Improving or Maintaining Physical Health and Mental Health, scored from the Health Outcomes Survey, rose from weight 1 to weight 3.
What practices can influence
The drug safety measures follow prescribing. The Technical Notes acknowledge that concurrent opioid and benzodiazepine use is sometimes appropriate, but the measure scores the overlap, not the reason. A plan can see the overlap in claims; only the prescriber knows whether it is intended. Practices already working on deprescribing are doing the work these measures reward.
For colorectal screening, exclusions matter as much as outreach. They include hospice, prior colorectal cancer or total colectomy, palliative care, and frailty with advanced illness at 66 and older. A patient who qualifies for an exclusion but lacks the documentation can show up as an open gap. The outcome measures are different: practices submit nothing, and no patient list can be chased.
What patients will ask
A star rating says nothing about whether your practice is in a plan's network. Patients may ask anyway, so front-desk staff should know where to send them: Medicare Plan Finder for ratings, and the plan itself for network status. Healthcare Dive also reported that more than 3 million seniors are in a plan that was terminated or left their county, so some patients will be choosing a new plan regardless.
What practices should do now
Ratings attach to contracts, identified by an H number, not to brand names. CMS posts the underlying data on its Part C and D performance data page. Pull the contracts that cover most of your Medicare Advantage panel and note which moved.
Then ask each major plan which measures it is targeting, whether its gap lists are claims-based or draw on your records, and how it handles exclusions. Check any gap list against the chart before acting on it. The 2027 ratings rest on 2025 claims and HEDIS data, so care delivered now will count toward ratings a year or two out, much as MIPS scores trail the year they measure.
Reported, fact-checked and edited by The Script Pad's editorial staff.
This article is for professional education and does not replace clinical judgment. Treatment decisions should be based on the individual patient and current guidelines.
