2026 Stars: What no one’s talking about

Coauthored by Mick Twomey, GM and VP Member Experience and Stars Analytics, Press Ganey.

Each fall, the release of CMS Star Ratings serves as a defining moment for Medicare Advantage (MA) plans. The 2026 release shows where plans are performing well, where member experience and quality are trending, and which strategies are paying off amid mounting pressures.

In this article, we’ll share the core themes emerging from this year’s results, highlight how leading health plans are maintaining or improving performance, and explore what comes next, as regulatory, financial, and consumer headwinds intensify.

The move to the middle continues

The member experience weight change in Stars 2026 continues a trend of disproportionately impacting high-performing plans.

While the number of 4+-rated contracts stayed roughly the same from 2025 to 2026, nearly a third of the 4-Star contracts from 2025 fell below 4 Stars—masked by the member experience weighting shift.

The impact of the weight change was disproportionately more negative on the high-performing plans.

• 78% of 4.5- and 5-Star contracts saw score declines
• 64% of 4-Star contracts saw score declines
• 49% of 3.5-Star contracts saw score declines
• 31% of 3-Star contracts saw score declines
• 6% of 2.5-Star contracts saw score declines

The upcoming removal of the Reward Factor is going to deliver another blow to high-performing plans in Stars 2027. Had this been applied to Stars 2026, 24 contracts would have dropped to 3.5 Stars and lost an estimated $650M in QBP.

The result of all of this is that it’s getting far more challenging to achieve or maintain 4+-Star performance given the existing and upcoming CMS rule changes. Plans must focus on every opportunity available to optimize Stars performance.

Why early action is essential ahead of calendar year 2026

The next Stars cycle will be here fast, and it brings new headwinds.

• Medicaid expansion, redeterminations and a new monthly SEP for duals will reshape membership and directly impact Star measures and methodology. 
• The Reward Factor ends in SY27, replaced by EHO4all, shifting rewards to equity performance.
• HOS takes on greater weight in SY27, making survey results central to ratings.
• New Part D measures will count in SY27, based on 2025 performance.

Proactive organizations are:

• Using simulations and predictive analytics to test strategies before surveys field.
• Building cross-functional Stars governance.
• Aligning investments with the measures most likely to move future ratings and revenue.

How leaders are maintaining and improving

High-performing plans show that consistency comes from discipline and foresight.

Leading organizations are:

• Embedding Stars into daily rhythm: Treating Stars metrics not as annual reporting requirements, but as part of the core daily operating rhythm.
• Incorporating the 5-weighted QI measures into that daily rhythm: Whether you’re trying to retain 4+ Stars in the wake of existing and upcoming rule changes or trying to achieve 4 Stars for the first time, the QI measures are a fantastic lever to optimize.
• Centering member experience: Recognizing that member perception drives overall Stars success, they invest in real-time listening, journey interventions, and provider alignment.
• Preparing early for HOS weighting increases: With HOS taking on greater weight in Stars 2027 (SY27), plans are already addressing physical health, mental health, falls, bladder control, and physical activity.
• Doubling down on provider partnerships: Stars outcomes depend on how well plans and providers close gaps and improve communication at the point of care.

Rising consumer expectations

Regulations shape the rules, but members shape the game. Seniors expect simple benefits, personalized communication, and coordinated care. CAHPS surveys will be back in members’ hands in March 2026. Strong onboarding of new members and proactive outreach to existing members are essential to protect survey performance and set the stage for future years.

>> Related read: Understanding health plan member discontent 

6 practical steps to take now

1. Manage SY26 impacts carefully: Understand how ratings affect CY27 revenue. If ratings dropped, avoid adding popular benefits that you may need to claw back.
2. Spend wisely: Prioritize investments that improve Stars and member trust—a CAHPS failure outweighs most other gains.
3. Stabilize operations: Avoid telephony changes during the call center study and train staff early.
4. Prepare members for benefit changes: Including formulary shifts. Work with prescribers to transition members before March CAHPS.
5. Push Q4 levers: Close HEDIS gaps, lock in adherence with 90-day fills, and ensure grievances, appeals, and call center interactions align with CAHPS expectations.
6. Set realistic performance goals: Focus on measures where small movements can shift results into significant improvement or prevent significant decline, maximizing the 5x-weighted Quality Improvement measures—a needed boost for plans losing the Reward Factor.

The 2026 Stars release shows that MA success isn’t just about compliance—it’s about foresight, adaptability, and member trust. While the numbers provide the scorecard, the real story is how plans respond. Reach out today to speak with one of our Stars experts.