The Centers for Medicare & Medicaid Services has finalized a rule that strips 11 measures out of the scoring system used to rate Medicare Advantage and Medicare Part D prescription drug plans on quality. The agency says the measures it dropped were focused on administrative processes and areas where nearly every plan already scores about the same, so removing them sharpens the rating system’s focus on care that genuinely differs from plan to plan. A new independent analysis finds the change carries a price tag: because it was not paired with other adjustments to how Medicare Advantage is paid, it is projected to add $18.6 billion to federal Medicare Advantage spending over the next decade.
That matters to the tens of millions of people enrolled in Medicare Advantage plans, since the star ratings behind that projection also determine which plans qualify for bonus payments that can shape premiums, rebates and extra benefits each year.
What the CY2027 Final Rule Removes From Star Ratings
The measure removals are part of a broader final rule covering Contract Year 2027 for Medicare Advantage and Part D, issued April 2, 2026, under file numbers CMS-4208-F3 and CMS-4212-F. Star Ratings currently score MA-PD contracts on up to 43 measures, MA-only contracts on up to 33 measures, and stand-alone Part D drug plans on up to 12 measures, spanning categories such as outcomes, patient experience and customer access. According to the CMS fact sheet on the rule, the agency is streamlining that measure set by removing 11 measures “focused on administrative processes and areas where beneficiaries cannot distinguish performance between plans due to high performance and little variation.”
Most of the removals take effect with the 2029 Star Ratings, which are based on how plans perform during the 2027 measurement year. Two measures come out a year earlier, starting with the 2028 Star Ratings: the Call Center Foreign Language Interpreter and TTY Availability measure for Part C and D, and the Statin Therapy for Patients with Cardiovascular Disease measure for Part C. In the same rule, CMS added a new Part C Depression Screening and Follow-Up measure beginning with the 2027 measurement year, and chose not to implement a planned “Excellent Health Outcomes for All” reward factor for the 2027 ratings, keeping the prior reward structure in place instead. The full regulatory text appears in the Federal Register notice CMS published April 6, 2026.
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Why Fewer Measures Can Mean More Bonus Money
Star ratings do more than help someone shopping for coverage compare plans online. A rating of four stars or higher on the five-star scale qualifies a Medicare Advantage contract for the quality bonus program, a system created under the Affordable Care Act that raises the benchmark, the maximum the federal government will pay for covering an enrollee, for higher-rated plans. Fewer measures generally means fewer chances for a plan’s overall score to be dragged down by a weak category, which pushes more contracts across the four-star line. That is exactly the mechanism KFF’s analysis, updated August 12, 2026, points to: trimming the measure set is a step toward a simpler rating system, but because it was not combined with other payment changes, it is projected to increase Medicare Advantage spending by $18.6 billion over the next 10 years, in part because more plans are expected to qualify for a bonus-program payment increase as a result.
How the Quality Bonus Program Turns Stars Into Dollars
Under the program’s mechanics, a plan that reaches at least four stars typically gets its benchmark increased by five percentage points, or 10 percentage points in certain high-enrollment urban counties designated for a “double bonus.” Plans too new or too small to receive a rating get a 3.5 percentage point increase instead. The rebate percentage, the share of the gap between a plan’s benchmark and its bid that gets paid back to the plan, also rises with higher star ratings: 70% for plans rated at least 4.5 stars, 65% for those between 3.5 and 4.5 stars, and 50% for anything lower. Insurers are not required to pass those additional dollars on to enrollees, but they can use them to lower Part B premiums, reduce cost sharing, or fund supplemental benefits such as vision, hearing and dental coverage that traditional Medicare does not include.
What Won’t Show Up in This Fall’s Enrollment Season
For anyone comparing Medicare Advantage plans during this year’s open enrollment window, the measure removals will not appear in the star ratings displayed for 2027 coverage. The 2029 Star Ratings that reflect most of the dropped measures are still two enrollment cycles away, built from how plans perform during the 2027 measurement year. In the meantime, plans currently marketing themselves are still being scored, and made bonus-eligible, under the fuller measure set CMS is now paring back.
A Longstanding Fight Over the Bonus Program’s Price Tag
The quality bonus program has drawn criticism well before this rule. The Medicare Payment Advisory Commission, an independent panel that advises Congress, and other researchers have argued for years that Star Ratings incorporate too many measures, do not adequately account for social risk factors, and are reported at the contract level rather than the plan level, even though a single contract can bundle plans with different benefits, networks and enrollees. In 2018, the Congressional Budget Office estimated that eliminating the quality bonus program entirely would lower federal spending by almost $100 billion over 10 years, and because Medicare Advantage enrollment, at roughly 35 million people in 2026, has grown well beyond what CBO projected at the time, KFF’s researchers note the savings from ending the program today would likely be larger still. The $18.6 billion projection tied to this year’s measure removals lands on top of that older debate over whether the bonus system rewards genuine quality improvement or simply sends more money to insurers.
This article was produced with AI assistance and reviewed by a human editor. Figures are linked to their primary sources; where a claim could not be verified from the public record, we say so.
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