2026 Star Ratings Shift: 4 Strategies for MA Plans

Estimated to total at least $12.7 billion in 2025, it’s hard to overstate the impact of quality bonus payments for Medicare Advantage plans. Established contracts that achieve a four-star rating or higher receive a 5% bump in benchmark payments made by the Centers for Medicare & Medicaid Services (CMS), giving them significant resources to invest in member care, operations, and customer service while also enabling them to attract more enrollees during open enrollment. Indeed, the stakes are so high that large national payers falling below this threshold have experienced immediate consequences in the marketplace when the annual ratings are announced each October.

Now, CMS is proposing major changes to the Star Ratings program, which has faced claims in recent years that it has not significantly improved quality while costing taxpayers a significant amount. Focused on improving quality, access, and competition among Medicare Advantage and Part D plans, CMS’s proposal centers on three main pillars:

1. Removing 12 administrative measures and two clinical measures – Citing high average performance and little performance variations across contracts, CMS proposes to remove measures including Complaints About the Health Plan, Members Choosing to Leave the Plan, Customer Service, and Call Center — Foreign Language Interpreter and TTY Availability. On the clinical side, Diabetes Care — Eye Exam and Statin Therapy for Patients with Cardiovascular Disease would also be removed with the rationale of streamlining the Star Ratings measure set and increasing the focus on patient experience and outcome measures. These measures would be removed beginning with the 2028 Star Ratings (based on 2026 measurement year data) or the 2029 Star Ratings (based on 2027 data).
2. Eliminating the Health Equity Index incentive – Originally proposed in 2023 for implementation in the 2027 Star Ratings, the Health Equity Index was renamed by the current administration to the Excellent Outcomes for All or EHO4all incentive in 2025. In eliminating it, the agency says rather than incentivizing improvement among certain populations such as dual-eligible or disabled enrollees, it would continue the historical reward factor to incentivize improved clinical care, outcomes, and patient experience across all enrollees.
3. Adding a measure for depression screening and follow-up – Citing that there are no specific behavioral healthcare measures in the Star Ratings, CMS says this measure would fill an important gap while supporting CMS’s efforts to implement a Universal Foundation set of measures across quality programs. It would be implemented beginning with the 2029 Star Ratings.

The potential impact to Star Ratings scores

These proposed changes, combined with continued tightening of Star Ratings program guardrails that had been relaxed during the most intense years of the Covid-19 pandemic, require continual vigilance from Medicare Advantage plans as they seek to improve or even protect their existing ratings. While the majority of contracts would likely see no change in their overall rating under the proposed measure retirements, as many as 25% could lose half a star — a significant drop when the stakes are this high.

Plans will also have to pay close attention to how measure category weights would shift. Between the 2027 and 2029 Star Ratings, survey measures (CAHPS and HOS) would shift from comprising 31% of contract’s total rating to 36%, while HEDIS and pharmacy measures would surge from 36% to 48%.

_{Figure 1. Proposed shift in measure category weights from 2027 to 2029 Star Ratings.} 

Recommended strategies for plan leaders

As the 2026 measurement year gets underway, which will ultimately impact performance in the 2028 Star Ratings, plan leaders don’t have much time to prepare for this potential shift. Here are four ideas to consider.

1. Stay focused on traditionally underserved populations. While the Health Equity Index/EHO4all incentive may be going away, the need to drive improved member care is not. In proposing to eliminate the incentive, CMS states that “any improvements in performance among these populations will still contribute to higher performance on the Star Ratings by increasing measure-level scores even without the implementation of the HEI reward.” Social determinants of health (SDOH)-informed outreach will remain critical in ensuring the most vulnerable members get the care they need by overcoming challenges in transportation, food and housing insecurity, and more.
2. Invest in the member experience. While some member experience measures such as Customer Service and Complaints About the Health Plan may be retired, overall, CAHPS and HOS surveys would represent a higher proportion of a plan’s overall score, indicating the focus on member experience is not going away. Strategies such as integrating valuable care gap data within customer service platforms and enhancing self-service through secure digital platforms will be crucial.
3. Tighten up data acquisition and personalization. As CMS looks to add behavioral health to the Star Ratings program, plans should work with providers to embed screening protocols into their primary care workflows and integrate behavioral health data into their existing reporting systems. As clinical outcomes gain additional weight, deploy predictive analytics to identify members at risk of developing care gaps and use it to inform targeted outreach, supplemented by artificial intelligence where feasible to personalize messaging.
4. Focus on clinical outcomes. CMS is making these changes to increase the focus on outcomes, not just processes. Member health is the ultimate measure of success. CMS wants plans to not just measure blood pressure, but to make sure it’s controlled. Ensure diabetic patients proactively control their blood sugar to avoid complications. Good quality preventative care leads to healthy members and lower costs for plans.

While further change in the Star Ratings program is inevitable, one thing won’t change: plans that make targeted investments in improving the member experience and clinical outcomes, driven by data, are the most likely to succeed and achieve a higher overall rating. The key is to be nimble and measure the ROI of previous initiatives to determine how to maximize the impact of limited budgets and resources.

Photo: Warchi, Getty Images

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