61 Medicare Advantage contracts sit one measure star from the 4 star line

CMS published the 2027 Medicare Advantage star ratings on Oct 8. CMS says they will affect 2028 quality bonus payments. Its fact sheet counts how many contracts reach 4 stars or more.

We rebuilt every rating from CMS’s own files. Then we changed one measure star at a time and ran the method again.

61 contracts with 5,745,014 members sit one measure star from that line. This is a SCENARIO, our analysis and not a CMS figure.

Chart: Health and Tech Now analysis of CMS files.

The contracts on the line

31 contracts rated 3.5 would reach 4 with one more star on a single measure. They have 1,684,184 members.

30 contracts rated 4 would drop to 3.5 with one star less on a single measure. They have 4,060,830 members.

Members are October 2026 counts. CMS hides enrollment for 2 contracts, and none of them is among the 61.

Diabetes drug adherence decides it most often

Medication Adherence for Diabetes Medications, measure D08, is the measure that moves the most contracts across the line. One star on it alone could lift 22 contracts to 4 and drop 28 to 3.5.

The next measures are close behind. D09 could lift 19 contracts. C14 and D10 could each drop 22. Three of the top five are drug adherence measures. They track whether members keep filling the drugs they are prescribed.

A contract counts once for each measure that could move it. So the measure counts add up to more than 61.

The adjustments inside the formula

CMS adds a reward factor for contracts that score high and steady across measures. Without it, 47 contracts with 6,106,464 members would fall below 4 stars. SCENARIO.

CMS also applies an adjustment for the mix of members a plan serves, called the CAI. Without it, 4 contracts would fall below 4 stars and 4 others would reach 4. SCENARIO.

One rating we could not match

Our rebuild matches 507 of 508 published Overall ratings, or 99.80%.

The one miss is H5141, a Clover contract. CMS rated it 5.0 without 20 measures, under a court order. Counting every measure, our rebuild gives 4.5.

What it means for you

Your plan’s star rating is on Medicare Plan Finder. Open enrollment runs through Dec 7, CMS says. A rating sums up many measures. For a plan near the line, one measure can move it half a star. If your plan is rated 3.5 or 4, the overall star tells you less than the measures behind it. Look at the ones you use, such as drug coverage, customer service and getting care quickly. If you take drugs for diabetes, blood pressure or cholesterol, whether members fill them on time is part of your plan’s rating.

How we did this

We started from CMS’s published measure stars for every contract. We applied the weights, improvement rules, reward factor, CAI, hold harmless rules and rounding in the 2027 Technical Notes.

We checked the rebuild only against CMS’s own files. 507 of 508 Overall ratings match. So do 515 of 515 Part C and 598 of 598 Part D summary ratings. Our star counts match Table 1 of CMS’s fact sheet at every level but two. CMS lists 15 contracts at 5 stars and 65 at 4.5; we have 14 and 66. The gap is H5141.

For the SCENARIO figures we changed one measure star by one and reran the full method. We held CMS’s cut points and thresholds fixed. We did the same with the reward factor or the CAI set to zero.

Members come from CMS’s monthly enrollment by contract for October 2026. Sources: CMS 2027 Star Ratings data tables, posted Oct 8, 2026. 2027 Technical Notes, dated Sept 30, 2026. 2027 Star Ratings fact sheet. CMS monthly enrollment by contract, October 2026. All downloaded Oct 31, 2026.