CMS is “voluntarily recalculating” 2027 Medicare Advantage quality bonus payment ratings, based on 2026 star ratings, following Clover Health’s successful challenge of the agency’s measures.
CMS sent a letter informing health plans June 17. In its reevaluation, CMS will only change a rating if a contract receives a higher quality bonus payment rating than before.
The agency removed all Part D and some Part C measures in its review: special needs plan care management, health plan complaints, members choosing to leave, timely appeals decisions, appeals decision reviews, and call center availability of foreign language interpreters and teletypewriters.
The agency clarified the recalculations should not be taken as a definitive policy for the 2027 star ratings and the ensuing quality bonus payment ratings.
Contracts with an upgrade have the option to resubmit contract year 2027 bids for a limited time. MA plans have until June 22 to indicate their interest in resubmission.
CMS recently upgraded Clover’s PPO star rating for 2026 from 3.5 to 4.5 after a federal judge ruled on the improper inclusion of 20 measures. CareFirst BlueCross BlueShield is also challenging its 2026 star ratings in court and has been granted a pause in the wake of Clover’s ruling. Many other plans could see upgrades, considering that 175 MA prescription drug plans fell just short of the bonus threshold and received a 3.5 rating for 2026, according to a 2025 fact sheet.
In 2024, CMS similarly recalculated star ratings amid methodology challenges from Elevance Health and SCAN Health Plan.
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