How many things does a star rating actually measure, and does the count mean the same thing from one plan type to the next? Under the Contract Year 2027 Medicare Advantage and Part D final rule, a Medicare Advantage plan that includes drug coverage is scored on up to 43 quality measures, a plan without drug coverage on up to 33, and a stand-alone Part D drug plan on 12. What the rule does not spell out for shoppers is that three measures were swapped out and three swapped in for the Star Ratings publishing this year, while a Depression Screening measure and a returning medication-therapy measure will not count until 2029. The scoring system beneficiaries use to compare plans, in other words, is mid-rebuild.
MA-PD Contracts Get 43 Measures, MA-Only Contracts Get 33
Star Ratings run from one to five stars and determine both the Quality Bonus Payments insurers receive and the rebate dollars a plan can spend on extra benefits, which is why the exact measure count matters beyond a comparison chart. CMS breaks the ratings into five categories, outcomes, intermediate outcomes, process, patient experience, and access, and it does not apply the same list of measures to every contract type.
CMS’s fact sheet on the Contract Year 2027 Medicare Advantage and Part D final rule states the agency is “currently rating” MA-PD contracts, meaning Advantage plans bundled with drug coverage, on up to 43 of those measures. MA-only contracts, the plans sold without embedded drug coverage, are rated on up to 33 of the same measure set, and stand-alone Part D prescription plans are rated on up to 12. The 43-measure ceiling applies specifically to the bundled MA-PD structure, the most common way Advantage plans are sold, not to Medicare Advantage as an undifferentiated category.
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Three Measures Out, Three In For The 2027 Star Ratings
CMS’s companion technical document, the 2027 Star Ratings Measures and Weights list, itemizes exactly which measures moved. Three measures are being removed beginning with the 2027 Star Ratings: Care for Older Adults – Pain Assessment, Medication Reconciliation Post-Discharge, and the MTM Program Completion Rate for Comprehensive Medication Review. Three measures are being added in their place: Care for Older Adults – Functional Status Assessment, Concurrent Use of Opioids and Benzodiazepines, and a polypharmacy measure tracking multiple anticholinergic medications in older adults.
The MTM completion measure is not gone for good. CMS’s document says it will sit on a public display page for the 2025 and 2026 measurement years before returning to the Star Ratings as a newly specified measure with the 2029 ratings, which are built from 2027 measurement-year data. A Part C Depression Screening and Follow-Up measure follows a similar delayed timeline, added starting with the 2027 measurement year but not counted in a published Star Rating until 2029.
CMS frames both the additions and removals as a shift toward outcomes. In the announcement accompanying the final rule, CMS Administrator Dr. Mehmet Oz said the changes “simplify the system, reward real improvements in health outcomes, protect patients when their providers leave their network, and reduce burdens that drive up costs,” and Chris Klomp, director of the Center for Medicare, described the effort as moving away from “administrative box-checking” toward a focus on clinical outcomes and beneficiary health, according to CMS’s press release on the rule.
Not every proposed cut survived stakeholder feedback. CMS confirmed it is retaining the Diabetes Care – Eye Exam measure in the Part C ratings rather than dropping it, citing its role in preventing serious complications. Separately, the 2027 Star Ratings will not carry the Excellent Health Outcomes for All reward, the renamed successor to the Health Equity Index reward built to credit plans for improving outcomes among specific enrollee subgroups; CMS said it will keep the older, broader reward factor in place instead while it works out a simpler methodology.
The Weighting Behind The Count, And What Still Isn’t Settled
The weighting behind these measures varies sharply, which is part of why a handful of swapped measures can move a plan’s overall Star Rating more than the raw count suggests. CMS’s measures-and-weights table assigns most process measures, including the three moving in and out for 2027, a weight of one, while outcome measures such as Plan All-Cause Readmissions carry a weight of three and the Health Plan Quality Improvement measure carries a weight of five. A newly added process measure with a weight of one moves a plan’s score far less than a shift in one of the higher-weighted outcome or improvement measures would, even though both count as one measure in the public tally.
The rule ties this measure overhaul to a broader deregulatory push, framed in the same announcement as cutting “regulatory burden and costs” for plans and providers. What neither CMS document discloses is how the specific swap of three lower-weighted process measures, against the higher-weighted measures still in place, is expected to move Quality Bonus Payments or rebate dollars once the 2027 ratings publish. The fact sheet states the mechanism and the categories; it does not publish a projected financial outcome for the contracts absorbing the change.
Beneficiaries comparing plans during this fall’s enrollment window will see the new 43, 33, and 12 measure counts embedded in Medicare’s plan-comparison tools without a public accounting of which specific measures shifted a given plan’s rating up or down. CMS’s own paper trail establishes the count and the categories; it stops short of showing how the 2027 changes, and the additional changes still queued for 2029, will move any single plan’s stars once the recalculated ratings are published.
This article was produced with AI assistance and reviewed by The Money Overview editorial team.
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