The Centers for Medicare & Medicaid Services (CMS) is proposing updates to the Medicare Advantage (MA) and Medicare Part D prescription drug programs to strengthen quality, improve access to care, and foster innovation in benefit design. The Contract Year (CY) 2027 MA and Part D proposed rule includes major enhancements to the Star Ratings system and seeks public input on new approaches to modernize MA to better serve beneficiaries and taxpayers.
“The Trump Administration is committed to ensuring Medicare beneficiaries have access to high-quality affordable care options,” said CMS Administrator Dr. Mehmet Oz. “This proposed rule continues that commitment by enhancing Star Ratings to reward meaningful improvements in quality and innovation, while making it easier for beneficiaries to compare and choose coverage that best meets their needs.”
CMS publishes MA and Part D Star Ratings each year on the Medicare Plan Finder website and on CMS.gov to measure the quality of health and drug services received by consumers enrolled in MA plans and Prescription Drug Plans (Part D plans). In the proposed rule, CMS is proposing enhancements to the MA and Part D Star Ratings that would incentivize MA and Part D plans to improve care for enrollees. Beginning in the 2027 measurement year, CMS proposes to streamline Star Ratings by removing measures focused on administrative processes or that do not convey variability in quality among plans. CMS is also proposing to maintain the current Star Ratings methodology that recognizes consistently high-quality care while considering ways to simplify the methodology in the future. CMS proposes not to move forward with implementing the Excellent Health Outcomes for All reward (previously called the Health Equity Index reward) and to continue to include the historical reward factor that incentivizes high and stable relative performance across measures.
The rule proposes the removal of 12 unique measures to create a more focused Star Ratings system that better serves the core purpose of measuring and incentivizing quality improvements that directly benefit people enrolled in MA and Part D, while reducing unnecessary administrative burden on plans. The changes retain many measures focused on clinical care, outcomes, and patient experience. CMS also proposes to introduce a new Depression Screening and Follow-Up measure that would begin with the 2029 Star Ratings to address critical mental health needs among beneficiaries. Together, these changes will rebalance CMS’s inventory of measures within the Star Ratings system to focus more on health outcomes and preventive care.
The rule also proposes to offer a new special enrollment period (SEP) for provider terminations and codify long-standing policy regarding utilization of SEPs.
CMS is also inviting public feedback through a new Request for Information (RFI) on how to modernize MA, examining options for improving competition, refining risk adjustment, and aligning quality incentives to deliver greater value for beneficiaries and taxpayers. The RFI seeks public input on ways CMS could achieve these efforts through either a time-limited model test under the CMS Innovation Center’s authority or potential program-wide regulatory changes.
The proposed rule will be open for public comment for 60 days following publication in the Federal Register here: https://www.federalregister.gov/public-inspection/current.
For more information, please view the fact sheet at: https://www.cms.gov/newsroom/fact-sheets/contract-year-2027-medicare-advantage-part-d-proposed-rule.
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