Are you ready? CMS just ignited the biggest Stars shake-up in a decade

December 5, 2025

David Shapiro

CMS didn’t just update the Medicare Advantage Star ratings program—they hit the reset button. Buried in a 465-page proposed rule released on November 25 is a major shake-up: 12 measures eliminated, the highly anticipated Excellent Health Outcomes for All (formerly HEI) reward scrapped and a return to the Reward Factor.

Why this matters:

A quarter of MA contracts could lose half a Star under CMS’ own modeling.
Our estimates show $1.3B in Quality Bonus Payment dollars will be lost based on applying the measure removals to the Stars 2026 results.
The removal of high-performing administrative measures eliminates the safety net many plans depend upon.
By 2029, CAHPS + HOS will make up nearly 40% of total Star weight.
The voice of the member will decide on market winners.

The new system rewards plans that excel in the hardest areas: closing gaps, clinical outcomes, disparities reduction, and earning member trust. This is the reality plans must now design around.

Translation: The era of winning Stars through operational compliance is over. Plans are now competing, and being paid, on clinical outcomes and authentic member experience. Those not already shifting in this direction are already behind.

What is CMS proposing to change

While most reading this blog know the specific changes, let’s summarize the proposed changes. On November 25, 2025, CMS released the CY 2027 MA & Part D proposed rule (comment period ends January 26, 2026), which includes a major revision to how Star Ratings will work.

Specifically:

CMS proposes removing 12 measures from the Star Ratings beginning with the 2027 measurement year (impacting 2029 Star Ratings).
- Operational and administrative performance (7)
  - Plan Makes Timely Decisions about Appeals (Part C)
  - Reviewing Appeals Decisions (Part C)
  - Special Needs Plan (SNP) Care Management (Part C)
  - Call Center – Foreign Language Interpreter and TTY Availability (Part C)
  - Call Center – Foreign Language Interpreter and TTY Availability (Part D)
  - Complaints about the Health/Drug Plan (Parts C & D)
  - Medicare Plan Finder Price Accuracy (Part D)
Process of care (3)
- Diabetes Care – Eye Exam (Part C)
- Statin Therapy for Patients with Cardiovascular Disease (Part C)*
- Members Choosing to Leave the Plan (Parts C & D)
Patient experience of care (CAHPS) (2)
- Customer Service (Part C)
- Rating of Health Care Quality (Part C)
CMS proposes to not implement the previously planned health-equity reward (formerly known as the Health Equity Index, now rebranded as Excellent Health Outcomes for All or “EHO4all”) for the 2027 Star Ratings. Instead, CMS would continue to use the historical Reward Factor.
To reflect evolving priorities, CMS proposes adding a new measure for Medicare Advantage (Part C): Depression screening and follow-up.
The rule also signals openness to future simplification of the Star methodology, soliciting feedback on additional streamlining, and possibly new outcome-focused measures (e.g., prevention, wellness, healthy aging).

In CMS’s own words, the goal is to “refocus the program on clinical care, outcomes, and patient experience where there is meaningful variation in performance across contracts,” while reducing administrative burden for plans.

A transformative impact on health plans

These changes are not cosmetic, they are market-shifting. They will reshape Stars performance drivers, contract competitiveness, and the flow of QBP dollars almost immediately. Every plan will be affected, but not evenly. Below are five realities MA executives can’t ignore:

1. Goodbye safety net: Operational measures no longer save you.

Plans that leaned on operational measures for easy lift will lose that advantage. With 12 measures gone, plans must shift focus to the tougher clinical and experience levers.

2. Volatility becomes the new normal.

Removing high-scoring administrative measures eliminates stable “base points.” With more weight on areas where performance varies widely, plans should expect bigger swings, making forecasting and financial planning more difficult.

3. The equity reward disappears, but expectations don’t.

Plans banking on the EHO4all equity bonus will lose that anticipated lift. CMS is reverting to the historical Reward Factor, meaning no (direct) extra credit for serving socially at-risk members.

4. Behavioral health plays a critical role.

The new Depression Screening and Follow-Up measure confirms CMS’s emphasis on behavioral health. Plans with strong behavioral health workflows and follow-up will benefit

5. Billions in QBP dollars will move.

Changes in measure weighting will directly affect QBPs, rebates, and competitive position. Plans may need to reallocate resources to protect revenue, adjust benefit design, and reposition in the market.

Real industry impact examples

To illustrate some of the impacts these changes will have on health plans, Press Ganey leveraged its Stars Monitor scenario planning tool to understand how all of these changes in Stars 2029, would have changed the 2026 Star Ratings for health plans.

89%: Contracts that would see their Stars scores decline
96%: National contracts that would see their Stars scores decline
$2.2B: Amount lost in Qualified Bonus Payments
-17: Average number of Star basis points lost
49: Contracts that would see their Stars scores improve resulting in $40.2M
446: Contracts that would see their Stars scores decline, or which 54 would also lose their Qualified Bonus Payment
-83: The largest basis point decline by a single plan
35: The largest basis point increase by a single plan

What health plans should be thinking about—and doing differently now

Given this likely reset, health plans have a window of opportunity—but only if they act now. Here’s what leaders should be prioritizing:

Re-evaluate Star Ratings strategy: Run “what-if” modeling to understand contract-level impacts under the new Stars math. Redirect resources as appropriate.
Strengthen and rethink clinical and behavioral outcome efforts: Accelerate work in clinical, behavioral health, and pharmacy. Ensure data systems support care-gap closure, follow-up workflows, and real-time modeling.
Double down on member experience, engagement, and trust: Invest in tools to understand member-level insights (simulations, predictive modeling, closed-loop). Enhance communication, navigation support, culturally competent care, and provider engagement.
Leverage data and analytics to monitor performance in real time: Shift from periodic compliance reporting to continuous performance monitoring. Use predictive analytics to target interventions for high-risk and underperforming populations.
Reassess equity efforts—but don’t abandon them: Even without EHO4all, equity-informed care remains essential to improving outcomes and experience.
Start preparing now: 2027 measurement year is around the corner: The 2027–2028 measurement years (impacting 2029 Stars) are approaching quickly. Standing up new workflows, data pipelines, outreach, screening, and care coordination takes time.

How Press Ganey can help navigate the new Stars era

Press Ganey is uniquely positioned to help plans navigate this shift toward outcomes and member experience. We bring the analytics, insights, and advisory expertise needed to realign Stars strategy for the new environment. Supported by solutions such as scenario modeling, simulations, experience measurement, and specialized consulting.

Stars Monitor helps model the impact of the new Stars framework and focus resources where they will matter most.
MA-CAHPS and HOS-like simulations provide member-level insights to prioritize the measures and people that move performance.
Experience measurement tools (like Med Practice Surveys and HX Exchange) surface the member and patient insights essential for plan–provider alignment.
Provider engagement efforts ensure that the provider community who see members are aligned and trained in supporting plans around key measures.
The Stars Center of Excellence translates regulatory change into clear, contract-level strategies and implementations.

Press Ganey provides the data, insights, and partnership plans value to succeed in a Stars program now defined by real outcomes and member trust.

What this means for the future

If finalized as expected, the CY 2027 rule will fundamentally reshape Stars. Removing administrative measures, pausing the equity reward, and elevating behavioral and clinical outcomes makes Stars a truer reflection of quality—and a tougher game to win. Plans that invest now in clinical outcomes, data integration, member experience, and engagement will pull ahead. Those that stay anchored in process compliance will fall behind.