Medicare Advantage Star Ratings

2027 Medicare Advantage Star Ratings: What Physicians and Medical Practices Need to Know

CMS’s latest Medicare Advantage Star Ratings reveal important changes in plan-level quality performance. Here is what physicians, practice administrators, and healthcare operations teams should understand before the 2027 enrollment year.

Quick Answer:

What Changed in the 2027 Medicare Advantage Star Ratings?

The Centers for Medicare & Medicaid Services (CMS) released its 2027 Medicare Advantage (MA) and Part D Star Ratings on October 8, 2026. The ratings will appear in Medicare Plan Finder for the annual Open Enrollment Period, running from October 15 through December 7, 2026.

According to CMS, approximately 37% of Medicare Advantage prescription drug (MA-PD) contracts – 188 contracts – received an overall rating of four stars or higher for 2027. When weighted by enrollment, approximately 71% of current MA-PD enrollees are in contracts with four or more stars.

The overall enrollment-weighted average rating decreased from 4.01 for 2026 to 3.99 for 2027. The new ratings also incorporate changes to selected quality measures, including medication safety, functional status assessment, and colorectal cancer screening.

For physicians and medical practices, the practical takeaway is not that every clinician will receive a new score or payment adjustment. Rather, the ratings provide a timely reason to review quality-measure workflows, documentation completeness, patient outreach, payer relationships, and the operational data that supports care delivery.

Source: CMS, 2027 Medicare Advantage and Part D Star Ratings.

1. What Are Medicare Advantage Star Ratings?

Medicare Advantage is the private-plan alternative to Original Medicare. Medicare Advantage organizations contract with CMS to provide Medicare-covered benefits and may offer additional benefits according to the terms of their plans.

CMS uses the Medicare Advantage and Part D Star Ratings system to evaluate the performance of participating health and prescription drug plan contracts. Ratings range from one to five stars, with five representing the highest performance category.

The program measures multiple aspects of plan performance, including selected clinical quality processes, member experience, access, customer service, complaints, and prescription drug services.

The ratings serve several purposes:

• Help Medicare beneficiaries compare coverage options.
• Give CMS a standardized way to assess plan performance.
• Encourage health plans to improve quality and service.
• Inform certain quality-related bonus payment calculations.
• Provide information that can influence plan competitiveness and enrollment.

Important distinction: Medicare Advantage Star Ratings are plan- or contract-level ratings, not a universal report card for individual physicians. A physician’s clinical quality, reimbursement, and contractual obligations cannot be determined from an insurer’s overall star rating alone.

Official reference: CMS, 2027 Medicare Advantage and Part D Star Ratings.

2. The Most Important Findings From the 2027 Ratings

CMS’s October 8, 2026 fact sheet provides several important findings.

Indicator	2027 finding	Why it matters
MA-PD contracts with four or more stars	188 contracts, approximately 37%	Fewer than half of rated contracts reached this threshold.
Enrollees in contracts rated four stars or higher	Approximately 71%	Enrollment is concentrated in higher-rated contracts.
Enrollment-weighted average MA-PD rating	3.99 stars, compared with 4.01 in 2026	The average rating edged down.
MA-PD contracts rated	508 contracts	Ratings cover a large, but not identical, set of contracts from year to year.
Medicare Open Enrollment	October 15–December 7, 2026	Beneficiaries can review 2027 coverage options.

Source: CMS, 2027 Medicare Advantage and Part D Star Ratings.

These figures need to be interpreted together. The proportion of contracts receiving four or more stars is not the same as the proportion of beneficiaries enrolled in those contracts. A relatively small group of higher-enrollment contracts can cover a large share of members.

The findings also do not establish that every plan’s performance declined. Individual contracts can improve or deteriorate, and CMS recalculates measure cut points each year. The appropriate approach is to examine contract-level and measure-level results rather than relying on the overall average alone.

3. What Changed in the 2027 Star Ratings Methodology?

CMS introduced, restored, or revised several measures for the 2027 ratings. These changes are especially relevant to healthcare organizations that support preventive care, medication safety, older-adult care, and quality reporting.

A. Concurrent use of opioids and benzodiazepines

The 2027 ratings introduce a measure addressing concurrent use of opioids and benzodiazepines.

These medications can create important safety concerns when used together. The measure brings additional attention to medication-use patterns and the need for appropriate clinical oversight.

What practices can do:

• Maintain accurate medication lists and reconcile them when clinically appropriate.
• Document medication reviews and relevant clinical decisions.
• Ensure medication-related concerns are communicated to the responsible treating clinicians.
• Use reliable follow-up processes when medication safety issues are identified.

This is not a recommendation to abruptly discontinue treatment. Medication decisions must remain individualized and clinically supervised.

B. Polypharmacy involving anticholinergic medications

CMS also added a measure concerning the use of multiple anticholinergic medications in older adults.

Polypharmacy means the use of multiple medications. In older adults, certain medication combinations may increase the risk of adverse effects and require careful review.

For practices caring for Medicare beneficiaries, this highlights the importance of maintaining accurate medication histories and documenting appropriate clinical assessment.

Operational teams can support this work by improving medication-list reconciliation, identifying missing information, and routing relevant records to clinicians. Technology should support—not replace—clinical judgment.

C. Functional status assessment for older adults

The Care for Older Adults—Functional Status Assessment measure returns to the ratings after a substantive specification change.

Functional status assessment helps document a person’s ability to perform relevant activities and may inform care planning for older adults.

Practices should review applicable measure specifications, identify the documentation required for their workflows, and ensure that completed assessments are recorded in the appropriate clinical systems.

A missing data element does not necessarily mean an assessment was not performed. It may indicate that documentation, data exchange, or reporting needs improvement.

D. Revised colorectal cancer screening measure

CMS replaced the legacy colorectal cancer screening measure with a respecified version treated as new for the 2027 ratings.

For practices, this is a reminder that measure definitions can change. A workflow that satisfied a prior specification may not automatically meet the updated requirements.

Quality teams should review the applicable technical notes, confirm eligibility and exclusion criteria, and check that screening information from outside facilities is captured when appropriate.

Source: CMS, 2027 Star Ratings Measures and Weights and the 2027 Star Ratings fact sheet.

4. Why These Ratings Matter to Physicians and Medical Practices

Although the ratings belong to health plans, the underlying healthcare environment depends on coordinated work among plans, physicians, hospitals, pharmacies, and other providers.

The relevance to a medical practice varies by specialty, payer contracts, patient population, and participation in quality initiatives.

Quality reporting and clinical documentation

Accurate documentation supports continuity of care, clinical decision-making, and applicable quality reporting.

Incomplete or inconsistent records can create avoidable work when organizations try to establish whether a screening, medication review, assessment, or follow-up activity occurred.

Practices can review:

• Completeness of relevant clinical documentation.
• Availability of external screening and specialist records.
• Consistency between the clinical record and submitted data.
• Workflows for identifying and resolving missing information.
• Internal processes for validating quality reports.

The goal is not to document care merely to improve a score. Documentation should accurately reflect care that was provided and clinical decisions that were made.

Preventive care and patient outreach

Measures involving screening and chronic disease care make patient outreach and follow-up processes worth reviewing.

For example, practices may use clinically appropriate registries or work queues to identify patients who appear overdue for a recommended service, confirm whether they received the service elsewhere, and contact eligible patients.

A reliable workflow should distinguish between:

1. Patients who are genuinely overdue.
2. Patients whose care was completed outside the practice but is not yet documented.
3. Patients who are not eligible under the applicable measure specifications.
4. Patients who need a clinical discussion before the next step.

This reduces unnecessary outreach and helps staff focus on unresolved care needs.

Medication safety and older-adult care

Medication-related measures may be particularly relevant to primary care, geriatrics, and practices that care for patients with multiple chronic conditions.

Operational support can include accurate medication lists, clear documentation, appropriate routing of concerns, and reliable follow-up processes.

However, no administrative checklist should substitute for a clinician’s assessment of risks, benefits, treatment alternatives, or patient preferences.

Care coordination and transitions

Older adults may receive care from several organizations. Relevant information can be distributed across primary care practices, specialists, hospitals, pharmacies, and post-acute providers.

Practices can review how they obtain outside records, reconcile medication information, communicate follow-up plans, and track unresolved care coordination tasks.

Better information flow can support safer care and reduce the administrative effort required to reconstruct a patient’s history.

5. Could Medicare Advantage Star Ratings Affect Physician Reimbursement?

Potentially, but the relationship is indirect and contract-dependent.

Medicare Advantage Star Ratings can influence certain payments to health plans. They do not automatically determine the amount an individual physician receives for a claim.

A physician’s payment generally depends on the applicable payer contract, fee schedule, covered services, coding and documentation requirements, claim adjudication, and any relevant value-based arrangement.

The distinction matters because practices should not assume that a plan’s rating increase will result in higher physician reimbursement—or that a lower rating necessarily means a physician’s contracted rate will decrease.

The more useful questions for practice leaders are:

• Does the practice participate in a value-based care or quality-incentive arrangement?
• Which measures are included in the agreement?
• How are results attributed to the practice or clinician?
• What reporting and documentation requirements apply?
• How are quality payments calculated, reconciled, and communicated?
• Are there contractual consequences for missed targets or incomplete submissions?

Before making financial projections, review the specific payer agreement and its methodology.

6. The Revenue Cycle Connection: Quality Data and Financial Operations

Quality performance and revenue cycle management (RCM) are different functions, but both depend on accurate information, consistent workflows, and effective follow-up.

RCM covers the financial process from patient registration and insurance verification through coding, claims submission, payment posting, denial resolution, and accounts receivable management.

Quality operations focus on measuring and improving care processes and outcomes. In some practices, these functions overlap through documentation workflows, patient records, eligibility information, reporting, and payer-specific requirements.

A coordinated operational review can examine several areas.

Eligibility and plan verification

Medicare Advantage benefits, networks, referrals, and prior authorization requirements can vary by plan.

Before a visit or service, practices should verify the patient’s current plan and applicable requirements rather than assuming that prior-year coverage remains unchanged.

Coding and claim accuracy

Claims should accurately reflect the services delivered and be supported by the medical record. Quality reporting should also use the appropriate specifications and validated data.

These are related data-quality responsibilities, but an accurate claim does not automatically establish that a quality measure has been satisfied, and a quality measure does not independently establish payment eligibility.

Denial management and accounts receivable

Practices can categorize denials by cause, payer, service, and workflow stage to identify recurring administrative problems.

For example, an increase in eligibility-related denials may justify a review of registration and verification processes. Documentation-related denials may require a different response, such as coding review or provider education.

Quality-rating changes alone do not prove that a payer will increase denials. Practices should use their own claims and payment data to determine whether a measurable change has occurred.

Analytics and operational reporting

A well-designed reporting process can help practice leaders monitor:

• Clean claim rate.
• Denial rate and denial reasons.
• Days in accounts receivable.
• A/R aging and collection trends.
• Eligibility and authorization errors.
• Documentation-related workflow issues.
• Relevant quality-measure completion and data gaps.

These metrics should be interpreted in context. A single indicator rarely explains the cause of a problem, and operational correlation does not establish causation.

7. A Practical Checklist for Medical Practices Before 2027

Physicians and practice administrators can use the following checklist to prepare for the new plan year.

Payer and enrollment readiness

• Review the Medicare Advantage plans commonly used by your patients.
• Verify network participation, benefits, referral rules, and prior authorization requirements.
• Confirm whether payer contracts or plan products are changing for 2027.
• Update front-desk and billing workflows with verified payer information.

Clinical documentation and quality workflows

• Review the current specifications for applicable quality measures.
• Confirm that medication lists and relevant assessments are maintained accurately.
• Check processes for documenting screening and preventive care completed elsewhere.
• Identify unresolved care gaps and establish clinically appropriate follow-up.
• Validate the completeness and accuracy of quality reports.

Revenue cycle readiness

• Review eligibility-related denials and other recurring payer issues.
• Monitor claim acceptance, denial trends, and A/R aging.
• Confirm that staff use current payer policies and documentation requirements.
• Reconcile payment variances against the actual contract and remittance information.

Governance and compliance

• Assign clear ownership for quality reporting and revenue cycle tasks.
• Protect patient information and restrict access to authorized personnel.
• Use documented review processes for corrections and data-quality issues.
• Avoid unsupported coding, retrospective changes without evidence, or documentation designed solely to influence a performance measure.

The objective is to create a repeatable process for identifying problems, validating data, and resolving issues—not to treat a plan’s star rating as a substitute for a practice-specific performance review.

8. What Should Practices Monitor During Medicare Open Enrollment?

The 2027 Medicare Open Enrollment Period runs from October 15 through December 7, 2026.

During this period, beneficiaries can review coverage options for the coming year. CMS’s Medicare Plan Finder provides plan information, including star ratings, benefits, and costs.

For practices, the period is an opportunity to reinforce routine insurance-verification procedures and prepare for potential changes in patient coverage.

Consider the following actions:

1. Verify coverage at the point of service. Confirm the exact plan and effective date instead of relying only on an old insurance card.
2. Check provider participation. Network status can differ by product and service area.
3. Confirm service requirements. Review referral and authorization rules before providing services when applicable.
4. Communicate administrative changes clearly. Give patients accurate information about scheduling, coverage verification, and next steps.
5. Review the first claims of the new year. Monitor rejections and denials for patterns that may indicate outdated plan information or workflow gaps.

A plan’s overall star rating does not establish whether a specific physician is in network. That question must be verified directly against the relevant plan and provider directory or confirmed with the payer.

9. Frequently Asked Questions

What are the 2027 Medicare Advantage Star Ratings?

They are CMS ratings of Medicare Advantage and Part D plan performance, published for beneficiaries to compare coverage options. The 2027 ratings were released on October 8, 2026.

What percentage of Medicare Advantage drug plan contracts received four or more stars for 2027?

CMS reported that 188 MA-PD contracts, approximately 37% of rated contracts, earned four or more stars. These contracts covered approximately 71% of current MA-PD enrollees when weighted by enrollment.

Do Medicare Advantage Star Ratings measure individual physician performance?

No. The ratings assess health plan contracts, not individual physicians as a universal score. A physician’s performance in a specific quality program must be assessed using the relevant program rules and data.

Can Star Ratings affect physician reimbursement?

They can influence health-plan payments and may matter within specific value-based arrangements. However, they do not automatically change an individual physician’s fee schedule or claim reimbursement. The applicable contract determines the relationship.

Which quality measures changed for the 2027 ratings?

Changes include the introduction of measures for concurrent opioid and benzodiazepine use and multiple anticholinergic medications in older adults, the return of a respecified functional status assessment measure, and a respecified colorectal cancer screening measure.

When does Medicare Open Enrollment begin in 2026?

The annual Open Enrollment Period begins October 15 and ends December 7, 2026. Changes made during this period generally apply to coverage beginning January 1, 2027.

How can a medical practice prepare for Medicare Advantage changes?

Practices can review payer participation, verify patient coverage, validate documentation and quality-reporting workflows, monitor claims and denials, and confirm applicable referral and authorization requirements.

Where can practices find the official Star Ratings?

CMS publishes the ratings and supporting technical information through its official Medicare Advantage and Part D performance-data resources. Beneficiaries can also compare plan information through Medicare Plan Finder.

Conclusion:

Turn Quality Information Into Operational Readiness

The 2027 Medicare Advantage Star Ratings provide an updated view of plan-level quality performance at a particularly important point in the annual coverage cycle. The decline in the enrollment-weighted average rating is modest, but the distribution of contract ratings and the updated measure specifications deserve attention.

For physicians and medical practices, the appropriate response is practical: maintain accurate records, support clinically appropriate preventive care and medication review, verify payer requirements, and use reliable operational data to identify workflow problems.

Quality performance, clinical care, payer contracts, and revenue cycle operations should not be treated as interchangeable. But when practices coordinate these functions effectively, they are better positioned to manage administrative complexity while keeping patient care at the center of their work.

MedLink Analytics supports healthcare organizations with medical billing and revenue cycle services designed to help practices manage claims, denials, accounts receivable, and related operational workflows. A disciplined approach to data quality and follow-up can help practice leaders make better-informed operational decisions.

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References and authoritative sources

1. Centers for Medicare & Medicaid Services (CMS). 2027 Medicare Advantage and Part D Star Ratings. October 8, 2026. Official fact sheet: https://www.cms.gov/newsroom/fact-sheets/2027-medicare-advantage-part-d-star-ratings
2. CMS. Part C and D Performance Data. Official Star Ratings tables and technical notes: https://www.cms.gov/medicare/health-drug-plans/part-c-d-performance-data
3. CMS. 2027 Star Ratings Measures and Weights. Technical information on measure changes: https://www.cms.gov/files/document/2027-star-ratings-measures.pdf
4. CMS. Medicare Advantage and Medicare Prescription Drug Programs Expected to Remain Stable in 2027. September 28, 2026. https://www.cms.gov/newsroom/press-releases/medicare-advantage-medicare-prescription-drug-programs-expected-remain-stable-2027
5. KFF. The Average Medicare Beneficiary Has 28 Medicare Advantage Prescription Drug Plan Options for 2027. October 1, 2026. https://www.kff.org/medicare/the-average-medicare-beneficiary-has-28-medicare-advantage-prescription-drug-plan-options-for-2027/

Editorial note: This article reflects publicly available information as of October 9, 2026. Star Ratings are plan-level measures, and individual physician obligations or financial effects depend on the applicable program rules and contracts. Practices should consult current CMS technical specifications and their payer agreements before changing clinical, reporting, or billing workflows.