2027 Medicare Advantage Star Ratings show gains in high-rated plan enrollment

More than 70% of beneficiaries in Medicare Advantage (MA) plans that include prescription drug coverage are in contracts rated at least four stars out of five, according to CMS’s Star Rating release for 2027.

Those plans are in line for quality-bonus payments and in 2028 will receive higher rebates that are used to support supplemental member benefits. Rebate percentages are 70% if a plan has at least 4.5 stars, 65% between 3.5 and 4.5 stars, and 50% below 3.5 stars.

Bonus-eligible contracts similarly have more room to fund supplemental benefits, and the impact also can trickle down to provider payment. Conversely, contracts that fall short of bonuses could make insurers more likely to tighten utilization management, implement narrow networks or seek rate concessions.

Medicare Advantage plan exits complicate 2027 enrollment

The Star Ratings for all plans are available on Medicare Plan Finder going into the Oct. 15 start of open enrollment. It could be a chaotic period for some beneficiaries among the 35.2 million who had MA coverage in 2026, with insurers scaling back their plan portfolio amid rising medical and benefit costs, along with changes in federal payment policy.

An Oct. 9 report in the New York Times cited an estimate that up to 5 million people would have to look for a new plan because their 2026 option would be unavailable. Other industry estimates are more conservative, according to the same report, yet still project the number to come out ahead of the corresponding figure heading into 2026, which was assessed to be as high as 2.9 million.

Per various reports, announced terminations of MA plans for 2027 have come from Aetna (affecting 950,000 members), Humana (600,000) and UnitedHealth Group (390,000), among others. In addition, KFF reported that 638,000 (1% of all Medicare beneficiaries) live in counties with no access to MA plans that include prescription drug coverage, up from 399,000 heading into 2026.

The insurers say their expectation is that some affected members can be funneled into sister plans.

Fewer MA contracts earn four stars

In the 2027 Star Ratings (available to download), only 37% of 508 Medicare Advantage Prescription Drug (MA-PD) contracts received four or more stars, down from 44.4% in 2026.

Of the eight insurers with at least 10 MA contracts in 2027, the technology-focused MA insurer Devoted Health had the largest share of contracts with four or more stars (18 out of 29, 62.1%). Humana was close behind (18 out of 30, 60%).

Other big insurers fared worse in that category, among them UnitedHealth Group (16 of 54, 29.6%), Centene (3 of 46, 6.5%), Aetna (11 of 39, 28.2%) and Elevance Health (8 of 37, 21.6%).

However, with the projected share of beneficiaries in four-star plans increasing from 67% to nearly 71% year over year, the distribution of enrollment among highly rated contracts has become more favorable. For example, although Aetna has a low share of four-star contracts, parent company CVS Health said more than 69% of members are enrolled in four-star or better plans (although that’s down from 81% in 2026).

Notably, the enrollment-weighted average MA-PD Star Rating declined only slightly, from 4.01 to 3.99, despite the larger drop in four-star contracts.

Smaller insurers and nonprofit plans post stronger ratings

MA insurers with fewer contracts generally performed well in the 2027 ratings. All nine of Kaiser Permanente’s contracts received at least four stars, including seven at 4.5 stars and one at five stars. Each of Longevity Health’s five contracts received five stars.

Roughly 44% of non-profit MA-PD contracts, some of which are provider-operated health plans, received four or more stars, compared with 34% of for-profit contracts.

Four contracts will carry the low-performing icon on Medicare Plan Finder, meaning they have earned fewer than three stars for three consecutive years. The high-performing icon goes to the 15 plans with five-star ratings.

Hospital-focused quality measures show gains and emerging challenges

MA-PDs were rated on up to 43 measures in CMS’s compilation of the 2027 Star Ratings. Among measures that have an evident hospital or health system touchpoint and improved in industrywide performance from 2026 to 2027 were Plan All-Cause Readmissions (2.9 to 3.4) and Transitions of Care (3.1 to 3.4). The latter is based on discharge-related components such as receipt of discharge information, post-discharge patient engagement, and medication reconciliation.

A measure assessing follow-up after emergency department visits for people with multiple high-risk chronic conditions dropped from 2.8 to 2.5, giving it the lowest average of any Part C measure. Plans thus could make those processes a point of emphasis in their provider relations.

The chief medical officer with a local MA plan that received a four-star rating for 2027 said working relationships with providers are always a key performance determinant.

“Timely and accurate information exchange is the key to a successful relationship between Medicare Advantage plans and providers. It is the oxygen for good patient care,” said Sanjiv Shah, MD, the CMO with MetroPlusHealth, which operates in New York City’s five boroughs. The effort “starts with building strong relationships with providers and their teams to understand who should receive relevant information and [to] establish efficient processes for collecting and sharing it.”

Approaches used by MetroPlusHealth in that endeavor, Shah added, include “helping primary care providers identify in-network specialists for quick and easy referrals and notifying community-based providers when patients are admitted in other facilities, to ensure the continuity of care.”