Every Medicare Advantage and Part D plan gets a public quality score each year, from one to five stars, and that score does more than help shoppers compare options. It also decides how much extra federal money a plan collects. Federal regulators had spent several years developing a new piece of that scoring formula meant to reward plans that got better outcomes for their most vulnerable members. That piece will not show up when the 2027 ratings are published. The Centers for Medicare & Medicaid Services confirmed in April that the reward is being shelved for at least another year, even as the rest of the ratings system keeps crediting plans that perform well across the board.
What the Health Equity Index Reward Was Built to Do
CMS had been developing a scoring bonus first known as the Health Equity Index and later renamed the Excellent Health Outcomes for All reward. The idea was to give an extra boost in the Star Ratings to Medicare Advantage and Part D plans that delivered strong results specifically for enrollees who carry certain social risk factors, such as people who qualify for both Medicare and Medicaid, those receiving the Part D low-income subsidy, or enrollees with a disability. Star Ratings already determine each plan’s Quality Bonus Payment and can shift the rebate dollars a plan is allowed to spend on lower premiums or extra benefits, so a new reward tied to equity outcomes was meant to push plans to close gaps that a simple average score can hide.
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CMS Confirms the Reward Is Off the Table for 2027
In an April 2, 2026 announcement covering the Contract Year 2027 Medicare Advantage and Part D final rule, CMS stated plainly that “for 2027 Star Ratings, CMS will not implement the Excellent Health Outcomes for All reward,” language the agency repeated in the rule’s companion fact sheet. The agency’s stated reason is that it wants to keep working on simplifying the Star Ratings methodology before adding a new reward layer tied to a subset of enrollees. That means the equity-focused bonus, which industry groups had been anticipating and preparing for, will not factor into how any plan’s 2027 star count is calculated.
The Historical Reward Factor Fills the Gap
Rather than leave a hole in the formula, CMS is keeping what it calls the historical reward factor, an existing mechanism that credits plans for consistently high performance across all of their quality measures and all of their enrollees, not just a subset defined by social risk. This factor has been part of the Star Ratings system before, so its continuation is a decision to stick with a broad-based reward rather than layer in the narrower one. CMS framed the move as part of a “fundamental shift” in how it evaluates quality, with the agency’s Center for Medicare director saying the focus is moving away from what he called administrative box-checking and toward the clinical outcomes and health of beneficiaries.
The Ratings Are Also Getting a Smaller Measure Set
The health-equity reward isn’t the only change buried in this rule. According to CMS’s final-rule fact sheet, the agency is removing 11 measures from the Star Ratings system, cutting items it says were either purely administrative or so uniformly high-performing across plans that they gave shoppers little useful basis for comparison. In their place, CMS is adding a new Part C Depression Screening and Follow-Up measure aimed at behavioral health gaps, starting with the 2027 measurement year and showing up in the 2029 Star Ratings. Today, Medicare Advantage prescription drug plans are rated on up to 43 measures, Medicare Advantage-only plans on up to 33, and standalone Part D plans on up to 12, spanning five categories that include outcomes, patient experience, and access to care. CMS did make one concession to stakeholder pushback: it is keeping the Diabetes Care – Eye Exam measure in the Part C ratings after originally floating its removal, citing the measure’s role in catching complications before they become serious.
What This Means When You Compare Plans This Fall
None of this changes what any single plan charges on its own, and it isn’t a cut to anyone’s benefits. What it changes is the scoring behind the star counts that show up on Medicare’s plan comparison tools once Open Enrollment opens October 15. A plan that would have picked up extra credit under the equity-focused reward next year will instead be judged the same way plans have been judged in recent years, through the historical reward factor and a trimmed set of quality measures. That reward factor sits alongside the payment cycle CMS runs every year, the same cycle that started in January 2026 when CMS proposed the 2027 Medicare Advantage payment policies that use Star Ratings to help set quality bonus payments. CMS has been explicit that this is a transitional step, not a final answer, saying in its own release that it is “laser-focused” on redefining what counts as quality while it keeps refining the methodology in future rulemaking. For now, the 2027 ratings will reflect the older, broader standard, not the more targeted one regulators had been building toward.
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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