SY 2027 Medicare Advantage Star Ratings Released
Medicare Advantage Star Ratings are out for SY 2027 and the news is not great. In general, the industry performed somewhat lower than SY 2026 despite those surges in cut points coming out of Plan Preview 2. The data below compares Sy 2027 to the revised “better of” ratings for SY 2026.
- The average rating across 508 contracts drops from 4.01 to 3.99.
- In SY 2026, 44.38% of contracts were 4-Star or greater. Now it is just 37.01%.
- Enrollment in 4-Star or greater contracts increases from 67.16% to 70.73%.
- Just 6 of 15 5-Star plans in SY 2027 are returning high performers.
- Here are the ups and downs:
— 88 contracts increased their rating
— 183 contracts saw drops in their rating
— 197 contracts have the same rating
— 40 contracts eligible for ratings have no rating in the data yet - Just 3 of the top 10 and 5 of the top 20 parent organizations with the highest enrollment increased their enrollment-weighted ratings. In the top 10, those are Humana, Kaiser Permanente, and BCBS Michigan.
- Humana moved its biggest enrollment plan back to 4.0, flipping its 4-Star and greater enrollment from the doldrums to 95%. United saw its 4-Star and greater enrollment drop to 68%. CVS dropped to 70%.
Additional article: https://www.beckerspayer.com/payer/medicare-advantage-plans-with-5-stars-in-2027/
#medicareadvantage #stars #quality #cms
Medicare Advantage Reform
Researchers at RAND surveyed Medicare Advantage experts about potential policy ideas and reforms. Showing the complexities of reform, the survey didn’t identify a single policy proposal that rose to the top and would benefit the three stakeholder groups surveyed. Three themes did rise to the top in terms of benefiting enrollees without significant disruption for plans or the government.
- Standardizing supplemental benefits
- Reforming commissions for agents
- Limiting the number of plans an insurer can offer
#medicareadvantage #reform
https://www.fiercehealthcare.com/regulatory/look-stakeholder-perspectives-medicare-advantage-reform
Other Healthcare News
A number of other healthcare topics from today:
Prime Therapeutics, one of the largest pharmacy benefit managers, aims to shift to upfront drug pricing and away from a complicated rebates-based system.
Michigan Attorney General Dana Nessel is accusing Blue Cross Blue Shield of Michigan of conspiring with other Blues plans to block competition and using its grip on the health insurance market to overcharge the state and underpay hospitals.
The Centers for Medicare and Medicaid Services (CMS) estimates that 77% of fiscal year 2025 Medicaid improper payments resulted from insufficient documentation rather than fraud or abuse.
Brand drug industry lobby PhRMA has filed suit to block implementation of CMS’ Part B most-favored-nation pricing GLOBE model.
A federal appeals panel largely panned the federal government’s arguments in an appeal of the striking down of a risk-adjustment validation audit regulation for Medicare Advantage.
Democratic Rep. Frank Pallone gets the pernicious effect of the No Suprises Act (NSA) arbitration awards. His new bill would replace the arbitration system with payments benchmarked to the median in-network rate for their services, adjusted for geography.
Additional articles: https://www.modernhealthcare.com/insurance/mh-prime-therapeutics-upfront-prices-drug-sales-model/ and https://www.beckerspayer.com/legal/michigan-accuses-bcbs-of-illegal-insurance-monopoly-in-new-lawsuit/ and https://www.beckerspayer.com/uncategorized/77-of-medicaid-improper-payments-tied-to-paperwork-not-fraud-report/ and https://cdn.aglty.io/phrma/attachments/PhRMAv.KennedyECFNo.1Complaint.pdf and https://www.statnews.com/2026/10/05/humana-medicare-advantage-radv-audits-lawsuit-hearing/
#healthcare
https://thehill.com/policy/healthcare/6136385-lower-premiums-faster-payments-act
— Marc S. Ryan
