CMS Proposes Star Ratings Change for Medicare Advantage & Part D Plans
Federal regulators are moving to revamp the Medicare Advantage Star Ratings program, signaling a shift in how insurers’ performance is measured and rewarded. The Centers for Medicare and Medicaid Services CMS Proposes Star Ratings Change; they issued a draft regulation, opening the door for public input on potential changes to Medicare Advantage policies, risk adjustment, and even the Medicare Part D prescription drug program.
The proposed overhaul comes as insurers face mounting pressure from prior authorization requirements, audits, and marketing restrictions. By streamlining the Star Ratings system, CMS may offer plans some relief while keeping the focus on high-quality patient care.
Watch a YouTube video on the discontinued Medicare Advantage special enrollment period
What’s Changing in Star Ratings
The Star Ratings program has significant financial implications for insurers. CMS awards Medicare Advantage and Part D plans that score at least four stars with a 5% payment bonus. Under the draft rule, the agency proposes removing a dozen measures that focus on operational performance or administrative processes rather than clinical outcomes.
Of the changes, eight measures would affect only Medicare Advantage plans, two would apply only to Part D, and two would apply to both programs. Examples include removing metrics tied to appeal decision timeliness, customer service, and members’ decisions to leave a plan. CMS notes that these measures “don’t sufficiently convey variations in quality among plans.” Most of the changes would take effect for the 2029 plan year.
Health Equity Index Eliminated
CMS also proposes ending its Health Equity Index, a 2024 initiative that rewarded plans for improving care for marginalized populations. Instead, the agency would continue the existing reward factor that incentivizes high performance across measures.
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New Focus on Clinical Care
The draft regulation highlights CMS’s intent to refocus Star Ratings on meaningful clinical outcomes. For example, the agency plans to add a depression screening follow-up measure to Medicare Advantage, reflecting an emphasis on behavioral health.
“These proposed changes aim to refocus the program on clinical care, outcomes and patient experience where there is meaningful variation in performance across contracts,” CMS said in a news release.
What This Means for Insurers and Beneficiaries
Insurers could benefit from a simpler Star Ratings system, with less emphasis on administrative metrics. For beneficiaries, the changes signal a stronger focus on health outcomes and patient experience rather than operational benchmarks. The public now has a chance to weigh in on the proposals before CMS finalizes the rule.