2027 Medicare Advantage Star Ratings: What the Preliminary Data Shows and What Plan Leaders Should Do Next
Key takeaways
- →CMS released preliminary 2027 Star Ratings showing a continued decline in the share of Medicare Advantage members enrolled in 4-star or higher contracts.
- →The industry-wide 4-plus star share is estimated at 35%, down from 41% in 2026 and 68% in 2023.
- →All five major national carriers saw their 4-plus star member share decline, with Humana and UnitedHealth absorbing the largest absolute drops.
- →Member-facing measures — getting needed care, care coordination, and appeals — drove the most significant score reductions.
- →Plans that maintained or improved ratings shared three operational traits: closed-loop care management, low administrative error rates, and documented grievance resolution workflows.
- →Bonus payment exposure is material: a plan moving from 3.5 to 4 stars gains approximately 5% in benchmark revenue per member.
In this article
CMS released preliminary 2027 Medicare Advantage Star Ratings in October 2026. The results continue a multi-year pattern: fewer members are enrolled in high-performing contracts, and the gap between plans that maintained strong ratings and those that declined is widening.
This article examines what the preliminary data shows, which operational factors separated high performers from declining plans, and what payer leaders should prioritize before the final ratings are published.
Medicare Advantage plans rated 4+ stars — industry trend
Share of enrolled members in 4-star or higher contracts · 2023–2027
2027 estimate (dashed) based on CMS preliminary data. Sources: CMS Star Ratings releases 2023–2026; CMS 2027 preliminary ratings.
What changed in the 2027 preliminary ratings
The preliminary 2027 ratings reflect performance data collected primarily during 2025. Plans are scored across five domains: staying healthy, managing chronic conditions, member experience, member complaints and changes, and health plan administration.
CMS updated the weighting methodology for 2027, increasing the weight assigned to member experience and complaints measures. That change amplified the effect of call center performance, grievance resolution timelines, and access-to-care scores on overall ratings.
The preliminary data shows that approximately 35% of Medicare Advantage enrollees are in contracts rated 4 stars or higher for 2027, compared with 41% in 2026 and 68% in 2023. The 2023 figure reflected a temporary adjustment CMS made during the COVID-19 public health emergency. The subsequent decline reflects both the removal of that adjustment and genuine performance deterioration across several large contracts.
35%
Members in 4+ star contracts (2027 est.)
↓ from 41% in 2026
~5%
Benchmark revenue gain per member, 3.5→4 stars
Material bonus exposure
3.4
Industry average Star Rating (2027 est.)
↓ from 3.55 in 2026
National carrier performance
All five major national carriers saw their share of members in 4-plus star contracts decline between 2026 and 2027. The magnitude of the decline varied, but no large carrier improved its overall position.
Humana entered 2027 with the highest 4-plus star share among national carriers at an estimated 58%, down from 71% in 2026. The decline reflects performance deterioration in several large contracts, particularly in markets where Humana has been managing elevated medical cost ratios.
UnitedHealth's estimated 4-plus star share fell from 52% to 41%. The company's 2025 operating challenges — including higher-than-expected medical costs and Optum Health restructuring — appear to have affected care coordination and access scores in several contracts.
CVS/Aetna, Elevance Health, and Cigna each saw declines in the 7–12 percentage point range. Elevance entered 2027 with the lowest estimated 4-plus star share among the five national carriers at 31%.
National carriers — members in 4+ star contracts
Estimated share of enrolled members · 2026 vs. 2027
Estimates based on CMS preliminary 2027 Star Ratings and 2026 enrollment data. Figures rounded.
Member-facing measures drove the decline
The 2027 weighting changes increased the influence of member experience and complaints measures on overall Star Ratings. Plans that had invested in clinical quality but not in administrative accuracy and member-facing workflows were disproportionately affected.
Getting needed care — which captures whether members can access specialists, get referrals approved, and receive timely care — showed the largest average decline across the industry. Care coordination scores, which reflect how well plans manage transitions and follow-up, also fell materially.
Appeals and grievances scores declined for plans that had high denial rates or slow resolution timelines during 2025. CMS weights these measures heavily because they reflect whether members can effectively challenge coverage decisions.
Member-facing measure scores — industry average
CMS Star Rating domain averages · 2026 vs. 2027 preliminary
Scores on a 1–5 scale. 2027 figures are preliminary estimates. Sources: CMS Star Ratings technical notes.
Customer service scores — which capture call center performance, hold times, and issue resolution — declined for plans that had staffing reductions or technology transitions during 2025. Plans that maintained consistent call center quality held their scores in this domain.
Regional plan performance
Regional plans showed more variation than national carriers. Several maintained 4-star or higher ratings by focusing on member experience and administrative accuracy rather than competing on benefit richness.
Plans that held their ratings in 2027 tended to operate in markets where they had strong provider relationships, low administrative error rates, and documented care management workflows. Plans that declined often had expanded into new markets or benefit categories during 2024 and 2025 without proportional investment in operational infrastructure.
Selected regional plans — Star Rating change
Overall Star Rating · 2026 vs. 2027 preliminary
Illustrative sample. 2027 figures are preliminary. Sources: CMS Star Ratings releases.
Bonus payment economics
Star Ratings directly affect Medicare Advantage benchmark payments. Plans rated 4 stars or higher receive a quality bonus payment of approximately 5% above the base benchmark. Plans rated 5 stars receive an additional increment and are exempt from the annual enrollment period lock-in.
For a plan with 100,000 members and an average benchmark of $1,200 per member per month, moving from 3.5 to 4 stars generates approximately $72 million in additional annual revenue. That figure does not include the indirect effects of improved member retention and reduced marketing cost that typically accompany higher-rated contracts.
Plans currently rated between 3.0 and 3.5 stars face a compounding problem: lower benchmark revenue reduces the resources available to invest in the operational improvements needed to raise ratings. Plans in this range that do not have a credible improvement plan are at risk of a multi-year decline.
Bonus payment illustration
A plan with 100,000 members and a $1,200/member/month benchmark moving from 3.5 to 4 stars gains approximately:
- →$6M/month in additional benchmark revenue
- →$72M/year before indirect retention and marketing effects
- →Exemption from enrollment period restrictions at 5 stars
Illustrative calculation. Actual bonus amounts depend on county benchmarks, risk scores, and CMS payment rules.
What high-performing plans did differently
Plans that maintained or improved their Star Ratings in 2027 shared three operational characteristics that distinguished them from plans that declined.
1. Closed-loop care management
High-performing plans documented care plan completion, follow-up contact, and transition handoffs at the member level. They could demonstrate that care management interventions were completed, not just initiated. Plans that tracked referral initiation but not completion scored lower on getting needed care and care coordination measures.
2. Low administrative error rates
Plans that held their ratings had lower rates of claims processing errors, authorization delays, and member communication failures. Administrative errors generate grievances, which directly affect the appeals and grievances domain. Plans with high error rates in 2025 saw those errors reflected in their 2027 preliminary scores.
3. Documented grievance resolution workflows
CMS audits grievance resolution timelines and documentation. Plans that maintained consistent resolution workflows — including documentation of the reason for each decision and the member communication sent — scored better on appeals and grievances measures than plans that resolved grievances informally or inconsistently.
Operational priorities for plan leaders
The 2027 preliminary ratings identify specific operational gaps that plan leaders can address before the final ratings are published and before 2028 performance data collection begins.
1. Audit care management completion rates
Review whether care plans are being completed and documented at the member level, not just initiated. Identify the share of high-risk members with documented follow-up contact within 30 days of a care plan update.
2. Map administrative error sources
Identify the claims processing, authorization, and member communication workflows that generated the most grievances during 2025. Prioritize error reduction in the workflows that feed directly into CMS-measured domains.
3. Standardize grievance documentation
Ensure that every grievance has a documented resolution reason, a member communication record, and a timestamp. Plans that cannot produce this documentation during a CMS audit face score reductions regardless of their actual resolution rate.
4. Review call center performance data
Pull hold time, first-call resolution, and escalation rate data for 2025. Plans with call center performance below industry benchmarks should identify whether the issue is staffing, technology, or workflow before 2026 data collection closes.
5. Model bonus payment exposure
Calculate the revenue impact of your current rating trajectory. Plans within 0.25 stars of a threshold should treat improvement as a financial priority, not just a quality initiative.
Frequently asked questions
When are the final 2027 Medicare Advantage Star Ratings published?
CMS typically publishes final Star Ratings in October of the year preceding the plan year. Final 2027 ratings are expected in October 2026. Preliminary ratings are released earlier and may differ from final ratings.
How do Star Ratings affect Medicare Advantage benchmark payments?
Plans rated 4 stars or higher receive a quality bonus payment of approximately 5% above the base benchmark. Plans rated 5 stars receive an additional increment and are exempt from the annual enrollment period lock-in for new members.
Which measures carry the most weight in the 2027 Star Ratings?
CMS increased the weight of member experience and complaints measures for 2027. Getting needed care, care coordination, and appeals and grievances are among the highest-weighted measures. The exact weights are published in CMS technical notes.
Can a plan appeal its preliminary Star Rating?
CMS provides a preview period during which plans can review their data and submit corrections for factual errors. Plans cannot appeal the methodology or weighting. Corrections must be supported by documentation.
What is the difference between a contract-level and plan-level Star Rating?
CMS assigns Star Ratings at the contract level. A single contract may include multiple plan benefit packages. The contract-level rating applies to all plans within that contract for bonus payment purposes.
How long does it take to improve a Star Rating?
Star Ratings reflect performance data collected approximately 18 months before the rating is published. Operational improvements made in 2026 will affect 2028 ratings. Plans should treat Star Rating improvement as a multi-year program, not a single-year initiative.
Sources
- →CMS Medicare Part C and D Performance Data
- →CMS Star Ratings Technical Notes
- →KFF: Medicare Advantage Star Ratings and Quality Bonus Payments
- →CMS Newsroom — Star Ratings Press Releases
2027 figures are preliminary estimates based on CMS data released in October 2026. Final ratings may differ. Carrier-level figures are estimates based on publicly available enrollment and contract data.
Strategic Advisor, Insurance Growth, Medicare Distribution, and Compliance
Farzin Espahani is a strategic advisor at VHealth Partners specializing in Medicare distribution, payer operations, and compliance. He writes about the operational and financial dynamics shaping Medicare Advantage plan performance.
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