What Health Plans Need to Do Now to Get Ahead on Medicare Star Ratings

Prepare Now for MY2026 and Beyond

Updated January 6, 2026

Medicare Advantage (MA) now serves over half of all Medicare beneficiaries. As enrollment climbs, so does the pressure to perform. CMS Star Ratings aren’t just a benchmark — they drive Medicare Advantage quality bonus payments (QBP), member trust, and long-term competitiveness.

The newly released CMS CY 2027 Medicare Advantage and Part D Proposed Rule signals a meaningful shift in the Star Ratings program. CMS is streamlining measures, reducing administrative noise, and doubling down on clinical outcomes, prevention, and medication quality. While some previously announced changes—like the Excellent Health Outcomes for All (EHO4all) reward—are no longer moving forward, the underlying direction is clear: plans must deliver measurable, real-world improvements for complex, high-risk members.

In this post, we highlight key updates to measures that plans must prepare for — and explore the most effective strategies to address them. Health plans that act now to leverage AI, clinical expertise, and scalable technology will be best positioned to address risk at the member level—driving higher quality of care and stronger Star Ratings.

Why Medicare Star Ratings Are Stabilizing—But Challenges Remain

While Star Ratings for 2026 appear to have stabilized, the longer-term trend tells a different story. In 2025 and 2026, the enrollment-weighted average for MA-PD contracts held flat around 3.92 to 3.98 stars, but this marks a significant decline compared to 4.37 in 2022.

The downward trend is even more pronounced for stand-alone Part D (PDP) plans, which historically lag behind MA-PD performance. In 2025, the enrollment-weighted average rating dropped to just 3.06 stars — one of the lowest points on record. Plans continue to struggle, especially with the tougher Part D measures.

Why scores remain under pressure:

• Temporary COVID-era boosts to scores have ended.
• Performance thresholds are tighter, and cut points have risen.
• Bonus payment growth is slowing.

These shifts make it harder to maintain, let alone improve, Star Ratings performance. With increased financial strain on plans, it is now also more important than ever for them to demonstrate real-world improvements in quality and outcomes, especially for high-risk members. Technology-enabled strategies are essential for scaling interventions and closing gaps before they affect ratings.

Medication Adherence Measures Are Changing: How to Adapt and Improve Performance

Starting in Measurement Year (MY) 2026, CMS is introducing major updates to adherence scoring—reflecting member complexity through new risk adjustment and weighting rules.

• Sociodemographic Status (SDS) Risk Adjustment: Adherence scores will now account for sociodemographic factors like age, gender, low-income subsidy, disability status, and dual eligibility.
• Triple-Weighted to Single-Weighted Adherence Measures: For the 2026 measure year, the triple-weighted adherence measures will be temporarily reduced to single-weighted, but are expected to return to triple-weighted in 2027.
• IP/SNF Stay Removal (PDC impact): Days when members are hospitalized or in skilled nursing facilities will no longer be excluded from Proportion of Days Covered (PDC) calculations. These inpatient stays may contribute to lower PDC scores, since medications are administered through the facility.

These shifts create both challenges and opportunities. Plans that act now will gain an edge when 3x weighting returns.

To prepare, plans should:

• Use machine learning to predict and prioritize risk: Incorporate dual-eligible, low-income subsidy (LIS), and disability data, along with other clinical and social determinants of health (SDOH) data, to prioritize members most likely to fall below adherence thresholds.
• Apply AI to tailor interventions that address social risk: Identify social risk factor (SRF) driven barriers to adherence, such as those related to dual eligible, low income, and disabled members — and tailor interventions based on strategies proven to work for members with similar profiles.
• Proactively address members impacted by IP/SNF stays: Build workflows to monitor discharges and resolve medication gaps for members transitioning out of inpatient or skilled care.

Health Equity: No Standalone Reward, but Still Central to Performance

CMS has proposed not to move forward with EHO4all (formerly HEI) in the 2027 Star Ratings. The historical Reward Factor will remain in place instead.

This removes a separate bonus tied specifically to social risk populations—but it does not remove the impact these members have on Star Ratings. The reality is that members with social risk factors still influence:

• Medication adherence scores
• Chronic condition outcomes
• CAHPS and patient experience measures

Plans that fail to close gaps for these populations will continue to see downstream Star Rating pressure—even without a named equity reward.

To succeed, plans should continue to:

• Track measure performance by SRF: Monitor outcomes for members with dual eligibility, low-income subsidy, and disability to ensure equitable care.
• Identify care gaps where performance among SRF members is lagging: Use data to pinpoint disparities in quality and outcomes.
• Personalize outreach to address SDOH barriers: Address challenges such as transportation, language barriers, and digital access through human-centered engagement.

Technology plays a critical role here. Arine’s AI-driven platform enables real-time identification of members with these social risk factors and empowers care teams to deliver tailored interventions that promote health equity.

MTM CMR Expansion: Why Now Is the Time to Scale Ahead of 2027 Scoring

CMS has made significant changes to the MTM Comprehensive Medication Review (CMR) measure. Eligibility criteria have expanded substantially — nearly doubling the number of members who now qualify. To allow time for adjustment, CMS paused this measure from contributing to Star Ratings, making it a display measure in MY2025 and 2026. While results will continue to be reported publicly, they will not impact plan scores during this period.

The increase in eligible members has made MTM one of the most challenging measures to succeed on, but it remains a critical touchpoint for engaging members and driving care. With scoring expected to resume in the 2027 measure year, plans need to use this time to refine internal processes, scale outreach, and ensure readiness for the broader member population in this measure.

Outcomes-Based Measure Set: Why Clinical Performance Matters More Than Ever

Alongside the changes to health equity, CMS is proposing a major restructuring of the Star Ratings measure set. The goal: streamline the program and place greater emphasis on measures that reflect meaningful differences in clinical quality and outcomes. These changes will affect MY2026 and MY2027 performance data used for the 2028–2029 Star Ratings.

CMS is proposing to remove twelve measures that are largely administrative, have consistently high performance across plans, and no longer differentiate quality. Of note is the proposed removal of Statin Therapy for Patients with Cardiovascular Disease (Part C) for MY2026, given limited performance variation between plans and the existence of other measures that cover similar clinical topics.

As the total number of measures shrinks, the remaining measures will carry more weight in the overall Star Rating. While clinical measures account for roughly 50% of the score in 2025 and 2026, they are expected to increase to approximately 65% of the overall score under the proposed 2027 structure. With fewer measures in play, plans will feel every point gained—or lost—more acutely in clinical performance areas.

In other words, every point gained—or lost—on adherence
and medication quality matters more than ever.

CMS is also proposing to add a Part C Depression Screening and Follow-Up measure, beginning in the 2027 measurement year and incorporated into the 2029 Star Ratings. This will help address a gap in behavioral health quality measurement that currently exists in the Star Ratings program, and underscore the association between behavioral health conditions and broader health outcomes.

To prepare, plans should:

• Reallocate resources toward high-impact clinical measures: Focus on pharmacy, chronic condition management, and behavioral health performance as their influence on Star Ratings grows.
• Strengthen integrated care workflows: Ensure depression screening, follow-up, and care coordination processes are clearly defined and scalable.
• Leverage pharmacy as part of whole-person care: Address the intersection of behavioral health with medication adherence, polypharmacy, and transitions of care.

As CMS streamlines the Star Ratings program, clinical measures will matter more—and matter more often. Plans that invest in strong clinical workflows, integrated behavioral health strategies, and scalable, data-driven interventions will be best positioned to succeed as the measure set becomes smaller and more impactful.

The Path Forward: Smarter Quality and Cost Improvement

CMS isn’t just raising the bar — it’s redefining what quality improvement means. As CMS finalizes 2026 Star Ratings measure updates and methodology changes, health plans should use these signals to guide upcoming quality improvement strategies and technology investments. Member complexity, social risk, and a robust medication management strategy are now central to performance.

For Medicare Advantage performance strategies, success demands precision, personalization, and speed — all areas where AI and data-driven platforms like Arine excel. And while these initiatives aim to raise the quality of care, the best solutions also deliver meaningful improvement in total cost of care — ensuring long-term sustainability and measurable ROI for health plans.

Key Takeaways:

• Adherence measures will be single-weighted and risk-adjusted for sociodemographic status, and the exclusion of IP/SNF stays from adherence calculations will end. Given that it will return to triple-weighting in MY2027, it’s important to maintain strong performance on these measures.
• EHO4all (formerly known as the Health Equity Index) is no longer proposed for the 2027 Star Ratings, but the performance of members with social risk factors still influences adherence. Equity-focused strategies remain essential to overall Star Ratings success.
• The MTM CMR measure has expanded eligibility and is a display measure through MY2026, with scoring expected to resume in MY2027, offering an opportune window for operational scaling in 2026.
• CMS is proposing to streamline the Star Ratings measure set, removing 12 administrative or low-variation measures and adding a new Part C Depression Screening and Follow-Up measure beginning in the 2027 measurement year (impacting 2029 Star Ratings). With fewer measures, clinical performance—including pharmacy and behavioral health—will carry greater weight in overall Star Ratings.

Stay Ahead with Arine

Navigating CMS changes isn’t just about compliance — it’s about building a smarter, more resilient strategy. At Arine, we help your team focus where it matters most. Our platform identifies the members who will have the greatest impact on quality measures by drawing from diverse data sets, including social risk factors. We deliver intelligent interventions tailored to what’s proven to work for each member profile. And we provide real-time insights at the moments they matter most — enabling faster action to improve quality scores throughout the measurement year. Let’s talk about how you can outperform in the next phase of Star Ratings.

Key Changes and Plan Priorities: