The U.S. Centers for Medicare & Medicaid Services (CMS) proposed rule changes for the 2027 Medicare Advantage and Part D contract year.
The goal is to refine plan performance metrics and simplify enrollment.
The agency said the updates will sharpen the Medicare Advantage program's value for beneficiaries and taxpayers while opening the door to future reforms focused on innovation and better health outcomes.
The proposal seeks public input on how CMS should steer the Medicare Advantage program in the years ahead, including ways to modernize care models and redesign benefits to better support patient health.
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A central element of the proposal is a revamp of the Star Ratings. The system guides beneficiaries in comparing plan quality and determines Quality Bonus Payments and rebates.
On Tuesday, Medicare Advantage-Prescription Drug contracts are rated on up to 43 measures, Medicare Advantage-only plans on up to 33, and Part D plans on up to 12, spanning outcomes, intermediate outcomes, process, patient experience, and access.
CMS is advancing major changes to the ratings framework. The agency plans to:
- Withdraw the previously announced Excellent Health Outcomes for All reward — formerly the Health Equity Index — for the 2027 Star Ratings cycle. Instead, CMS intends to continue using the long-standing reward factor that recognizes contracts delivering consistently high performance across quality measures.
- Streamline the measures set by removing 12 process-heavy or administrative measures where plan performance has grown uniformly high, reducing meaningful variation.
- Add a Part C Depression Screening and Follow-Up measure, beginning with the 2027 measurement year and informing 2029 Star Ratings, to address persistent behavioral-health gaps.
The changes would allow plans to concentrate on clinical care, measurable outcomes, and patient experience. It should also ease administrative tasks tied to measures that no longer differentiate performance.
The proposal also includes steps to simplify enrollment. CMS is recommending a new special enrollment period for Medicare Advantage enrollees whose providers leave their plan's network mid-year.
The adjustment removes the requirement that a network change be deemed "significant." This makes it easier for beneficiaries to switch plans while keeping their preferred providers, the agency explained.
Additionally, CMS plans to codify its long-standing policy that specific special enrollment periods require prior agency approval.
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