About half of the thresholds that determine Medicare Advantage star ratings became harder to reach for 2027, according to draft figures the Centers for Medicare and Medicaid Services released this week as part of its preview process. Roughly a third were unchanged, and 17% became easier, based on analysis reported by Healthcare Dive from the consultancy Newton Smith Group.
These are draft numbers. CMS announces official star ratings in early October, days before Medicare's annual enrollment period opens on October 15, and the agency typically leaves room for plans to flag calculation errors before then, though the thresholds themselves rarely move much between preview and final release.
For the tens of millions of people enrolled in Medicare Advantage, the immediate relevance is timing. The star rating displayed next to a plan on Medicare Plan Finder in October is the number this process produces, and it is one of the few standardized quality signals available when comparing plans.
Ratings Measure More Than Clinical Care
A star rating combines dozens of individual measures into a single score from one to five. They fall into several categories: clinical quality, including screenings, vaccinations and chronic disease management; member experience, drawn from enrollee surveys; customer service and complaint handling; and for plans with drug coverage, measures of medication safety and adherence.
The mechanism that drew attention this week is the cutpoint. CMS does not set fixed performance standards in advance. It recalculates the thresholds each year based on how all plans actually performed during the measurement period. If plans across the industry improve on a measure, the bar for earning four or five stars on that measure rises accordingly.
That design means a tightening cutpoint is not necessarily CMS making life harder for insurers. Most of the tightening this cycle landed in HEDIS measures, a 90-metric framework covering how accessible and effective a plan's care is, where thresholds are rising as plans invest more in data collection. The kidney health evaluation measure for patients with diabetes rose by 7 to 10 points depending on the star level, and colorectal cancer screening tightened by 4 to 11 points. CMS also dropped three measures entirely for 2027: pain assessment in older adults, medication reconciliation after hospital discharge, and medication therapy management reviews.
The financial stakes explain the industry attention. Contracts reaching four stars qualify for higher federal bonus payments, and higher scores also produce larger rebates when plans bid below the CMS benchmark.
The measure set itself is also in flux. CMS finalized a structural overhaul of star ratings earlier this year, cutting roughly a dozen metrics and reverting to an older bonus formula, changes projected to send more than $18 billion in additional payments to plans over the next decade. Most of those changes apply to the 2027 measurement period and inform ratings in 2029. A law firm review of the measure changes noted that call center and statin-related measures that plans had objected to are among those being removed.
Average ratings have moved. After several consecutive years of decline, average Medicare Advantage star ratings for 2026 were essentially flat. The earlier declines prompted a series of lawsuits from insurers disputing how CMS calculated their scores. Melissa Newton Smith told Healthcare Dive that CMS used for 2027 the same underlying methodology one insurer had already successfully challenged, adding that "we very well might see a wave of lawsuits" and that "to say this is a volatile year would be an understatement." Industry analysis of the 2027 final rule and rate notice has pointed to the same tension between short-term stability and longer-term accountability.
The Rating Is a Signal, Not a Verdict on Your Care
Stars are useful for comparison and weak as a prediction of individual experience, and both halves of that matter when choosing a plan.
The composite hides variation. A plan can earn four stars overall while performing poorly on the specific measure that matters to a particular enrollee, such as appeals handling or availability of a needed drug. A member managing diabetes and a member who rarely sees a doctor are affected by entirely different components of the same score.
Ratings also lag. The measurement period runs well ahead of publication, so a 2027 rating reflects performance from an earlier year. A plan that has since changed its provider network or pharmacy benefit may not look the same in practice as its score suggests.
The practical use is comparative rather than absolute. A gap between a 4.5-star plan and a 3-star plan in the same county is meaningful. A difference between 3.5 and 4 is thinner than the number implies, particularly given that the underlying thresholds shift annually.
Bonus payments do reach members indirectly. Plans use them to fund supplemental benefits such as dental, vision and over-the-counter allowances. When ratings fall across a market, those extras are often where insurers trim, which is the pathway by which a technical rating change becomes a benefit change in the following year.
Checking a Plan Before the December 7 Deadline
Medicare's annual enrollment period runs October 15 through December 7, with changes effective January 1. That window is when star ratings become visible and comparable on Medicare Plan Finder.
Start with the annual notice of change every plan mails in late September. It lists what is changing in premiums, cost sharing, drug coverage, and supplemental benefits for the coming year. Reading it is the single highest-value step, because plans change beneath enrollees who auto-renew.
Then verify three specifics that a star rating does not capture. Confirm that your doctors and preferred hospital remain in network for the exact plan, not the plan family. Confirm each of your prescriptions appears on the 2027 formulary and check its tier. Confirm whether prior authorization requirements changed for any service you use regularly.
Free help exists. State Health Insurance Assistance Programs provide unbiased counseling at no cost in every state, and their counselors are not paid on commission. Medicare's helpline is available around the clock.
One habit is worth more than any rating: do not auto-renew without comparing. Plans change networks, formularies and supplemental benefits every year, and last year's best fit is frequently not this year's, even when the star rating has not moved.
What remains unknown is where 2027 ratings will actually land, since draft cutpoints are not final and CMS has adjusted before. Analysts have suggested some large insurers could see contracts slip below four stars, and further litigation is possible. Official results are expected in early October, which is when the numbers become usable for the decision in front of members.
Key Questions Answered
What is a cutpoint? The score threshold CMS uses to convert a plan's performance into a star level. Cutpoints are recalculated each year based on how plans actually performed.
Why did half of them get harder? Often because plans across the industry improved on those measures, which raises the bar. Changes in which plans are in the pool also affect the calculation.
Are these the final ratings? No. These are draft preview figures. CMS announces official star ratings in early October.
What do star ratings measure? Clinical quality, member experience from surveys, customer service and complaint handling, and for drug plans, medication safety and adherence.
Does a star rating predict my experience? Only loosely. The composite can hide weak performance on the specific measure that matters most to an individual enrollee.
How do ratings affect benefits? Plans at four stars or higher receive bonus payments that often fund dental, vision, and over-the-counter allowances. Falling ratings can mean trimmed extras.
When can I change plans? October 15 through December 7, with changes effective January 1. Free counseling is available through State Health Insurance Assistance Programs.
