Medicare Star Ratings Explained: 2027 Guide for Agents

Medicare Star Ratings are CMS's 1-to-5 star scores for how well Medicare Advantage and Part D contracts perform on quality and performance measures. On CMS's whole-star scale for measures and domains, five stars means Excellent and one star means Poor, and summary and overall ratings can include half stars. CMS published the 2027 Star Ratings on Medicare Plan Finder on October 8, 2026, and clients see them during the 2027 Open Enrollment, October 15 to December 7, 2026.

This guide covers how ratings are built, what changed for 2027, how the 5-star Special Enrollment Period and the low-performing icon work, and what the marketing rules let you say about stars. It ends with a way to explain ratings that keeps the client's decision tied to their own needs.

Key takeaways

• CMS rates the contract, not each plan benefit package. Every plan under one contract shows the same rating.
• CMS sets cut points for each measure and recalculates them every year. CMS says year-over-year changes in ratings are normal and expected and vary by measure.
• The 2027 ratings rely mostly on 2025 data and will affect 2028 MA quality bonus payments.
• For the 2027 plan year, the 5-star SEP can be used one time between December 8, 2026 and November 30, 2027, if a 5-star plan is available in the client's area. Check drug coverage before any move.
• Four MA-PD contracts carry the low-performing icon for 2027.
• Medicare.gov describes a separate SEP for people in a plan with a star rating below 3 stars for the last 3 years. Confirm eligibility with the carrier or 1-800-MEDICARE before relying on it.
• When you cite stars, say "out of 5," name the contract year, and include the overall or summary rating with any claim about a single measure.

What are Medicare Star Ratings?

The 2027 Star Ratings Technical Notes give each whole-star level of the 5-star scale a label, the scale used for measures and domains. Summary and overall ratings can include half stars.

Are Star Ratings given to a plan or to a contract?

To the contract. The Technical Notes say Star Ratings data are reported at the contract (sponsor) level, not for individual plan benefit packages. Two plans with different premiums and networks can show the same rating because they sit under the same contract.

That means a rating tells you how the contract performed. It doesn't tell you whether a particular plan's network, formulary, or costs fit your client.

How are Medicare Star Ratings calculated?

How many measures are there?

According to the CMS 2027 Star Ratings fact sheet, contracts are rated on up to:

• 43 unique measures for MA-PD contracts
• 32 for MA-only contracts
• 13 for standalone PDP contracts

The 2027 ratings mostly use data from measurement year 2025. That data comes from four kinds of sources: health and drug plans, surveys of enrollees, CMS contractors, and CMS administrative data.

How are the measures weighted?

For 2027, the Technical Notes rank the weights from highest to lowest:

1. Improvement measures
2. Outcome and intermediate outcome measures
3. Patient experience/complaints and access measures
4. Process measures

New measures get a weight of 1 in their first year.

What are cut points?

Cut points are the thresholds CMS sets for each measure. They decide whether a contract's performance earns one, two, three, four, or five stars on that measure. CMS recalculates them every year based on performance during the measurement period, so the score that earned 4 stars last year might not earn 4 stars this year.

Summary rating vs. overall rating

MA-PD contracts get both a Part C and a Part D summary rating, MA-only contracts get a Part C summary rating, and standalone PDPs get a Part D summary rating. For MA-PD contracts, the overall rating is a weighted average of the Part C and Part D measure stars. When marketing cites a single measure, the rule requires the overall rating for an MA-PD contract and the summary rating for an MA-only contract (more on that below).

When do the 2027 Star Ratings come out, and when do they take effect?

What changed for the 2027 Star Ratings?

New and retired measures

The CMS fact sheet lists these measures among those added for 2027:

• Concurrent Use of Opioids and Benzodiazepines (COB)
• Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH)

Two measures were retired: Care for Older Adults - Pain Assessment, and Medication Reconciliation Post-Discharge.

These aren't the only measure changes for 2027. Check the Technical Notes for the full list of new measures and their weights before you explain a rating change to a client.

Health Equity Index reward

According to the CY2027 final rule fact sheet, CMS did not implement the Excellent Health Outcomes for All (Health Equity Index) reward for the 2027 ratings. It kept the historical reward factor.

Which measures are being removed, and when?

The CY2027 final rule removes 11 Star Ratings measures that focus on administrative processes or show little variation. It also adds a Part C Depression Screening and Follow-Up measure, starting with the 2027 measurement year and the 2029 Star Ratings.

Under the final rule in the Federal Register, most removals apply to the 2027 measurement period and the 2029 Star Ratings. Some measures come out earlier, starting with the 2028 Star Ratings:

• The Call Center - Foreign Language Interpreter and TTY Availability measures
• Statin Therapy for Patients with Cardiovascular Disease

CMS kept Diabetes Care - Eye Exam. Under the final rule, the removals apply starting with the 2028 and 2029 Star Ratings, not the 2027 ratings.

Do higher stars mean lower premiums or better benefits?

Not directly. CMS says Star Ratings determine Quality Bonus Payments and affect rebates for MA contracts. The rating is a quality score for the whole contract, though, not a price or a list of benefits.

Look up each plan's premium, drug costs, and benefits in Plan Finder before you draw any conclusion from its stars. Our Medicare Plan Finder guide walks through a full needs analysis.

Why do ratings change from year to year?

CMS says year-over-year changes in Star Ratings are normal and expected, vary by measure, and reflect a contract's performance during the measurement period. Several things can move a rating:

• Cut points are recalculated every year based on how all contracts performed.
• The 2027 ratings mostly reflect 2025 performance, so they may not match what members experience today.
• Measures get added and retired, and the weights differ by measure type.

The number of 5-star contracts changes too. For 2027, 15 MA-PD contracts earned 5 stars and carry the high-performing icon on Plan Finder, down from 22 MA-PD contracts with 5 stars in 2026.

What is the 5-star Special Enrollment Period?

Medicare.gov says that if a Medicare Advantage Plan, Medicare drug plan, or Medicare Cost Plan with a 5-star overall rating is available in the person's area, they can use the 5-star SEP one time between December 8 of the year before the plan year and November 30 of the plan year.

Can a client in a 5-star plan switch to another 5-star plan?

Medicare.gov's description ties the SEP to a 5-star plan being available in the area, and it allows one use per window. It doesn't name the client's current plan rating as a condition. Before you submit, confirm the specific situation and the effective date with the carrier and your upline. See our Medicare enrollment periods cheat sheet for how SEPs fit with the other election periods.

What happens if a client moves to a plan without drug coverage?

Medicare.gov warns about two outcomes:

• Moving from an MA plan with drug coverage to a stand-alone 5-star drug plan disenrolls the person from the MA plan and returns them to Original Medicare.
• Moving to a 5-star MA plan without drug coverage may mean losing drug coverage until the next enrollment opportunity, possibly with a Part D late enrollment penalty.

As advice, ask every 5-star SEP client what they take, and write down their answer on how they'll keep drug coverage before you go further.

What does the low-performing icon mean?

Under the Technical Notes, a contract gets the low-performing icon (LPI) if any combination of its Part C and/or Part D summary ratings was 2.5 or lower in each of the current year and the past two years. For 2027, that means the 2025, 2026, and 2027 Star Ratings.

Four MA-PD contracts carry the LPI on Plan Finder for 2027. CMS says four contracts received the icon the year before.

Separately, Medicare.gov describes a Special Enrollment Period for people in a plan that has had a star rating of less than 3 stars for the last 3 years. They can switch to a Medicare Advantage Plan or Medicare drug plan any time while they're in that plan. The icon and this SEP are defined in different places, so confirm with the carrier or 1-800-MEDICARE that your client qualifies, and check the effective date, before you rely on it.

Contact only clients who have agreed to hear from you. Our guide to selling Medicare over the phone covers the contact rules.

What can you say about Star Ratings in marketing and on sales calls?

Rules for citing stars

42 CFR 422.2263(c) says plan marketing that references Star Ratings must:

• Make clear the rating is out of 5 stars
• Clearly identify the Star Ratings contract year
• Include the overall rating (MA-PD) or summary rating (MA-only) when citing individual measures
• Not use a single category or measure rating to imply a higher overall rating
• Market ratings only in the service areas where they apply, unless the marketing conveys overall MA organization performance in a way that isn't confusing or misleading

Two more provisions apply to the ends of the scale:

• 5-star SEP cutoff (422.2263(c)(6)): A 5-star MA contract may not market the 5-star SEP after November 30 if it didn't receive an overall 5 stars for the next contract year.
• Low performers (422.2263(c)(7)): Low-performing MA contracts must include the Low Performing Icon on all materials that reference the contract's Star Ratings. They must state that the icon means a summary rating of 2.5 stars or below in Part C, Part D, or both for the last 3 years, and they may not try to refute or minimize low-performing status.

Under 422.2263(b)(5), MA organizations may not compare their plan to other plans in marketing unless the information is accurate, not misleading, and can be supported. Ask your carriers how these rules apply to your own ads, mailers, and social posts.

Can you still call a plan "the best" or "top-rated"?

The CY2027 final rule removed paragraphs (a)(1)(i) and (ii) from 42 CFR 422.2262, which deleted the ban on superlatives without supporting documentation. Marketing still must not mislead, confuse, or give materially inaccurate information, and the Star Ratings rules above still apply.

As advice, skip "the best" and state the rating the way the rule describes: "rated 4.5 out of 5 stars for 2027."

Is the 48-hour Scope of Appointment wait still required?

Not for contract year 2027 marketing. Starting October 1, 2026, the CY2027 final rule removed the 48-hour waiting period between completing a Scope of Appointment and a personal marketing appointment, along with its two exceptions, for contract year 2027 marketing and communications. Confirm with your carriers how it applies to any appointment about 2026 coverage. You still need an SOA agreed to in advance, just without a set timeframe. Our Scope of Appointment guide and Medicare marketing guidelines guide cover the details.

How do you explain Star Ratings to clients without steering them?

Treat stars as one factor, next to doctors, drugs, pharmacies, and total costs. Lead with the client's needs, then add the rating as context.

A script you can adapt (advice):

"Medicare gives each plan's parent contract a quality score from 1 to 5 stars. This one is rated [X] out of 5 stars for 2027. That rating covers the whole contract, not just this plan. What matters more for you is whether your doctors are in network, your medications are covered, and what you'd pay over the year. Let's check those first, and then you can weigh the rating however you like."

For a client in a plan with the low-performing icon:

"Your plan's contract shows a low-performing icon on Medicare Plan Finder for 2027. Medicare.gov says people in a plan that's had a rating below 3 stars for the last 3 years may be able to switch to a Medicare Advantage Plan or a Medicare drug plan while they're in it. I'll confirm whether that applies to you before we go further. You don't have to change anything. Would you like to review your options against your doctors and prescriptions?"

Let the client make the call, and write down their reasons in their own words.

How to review your book after the October release

1. Look up each client's contract rating for 2027 in Medicare Plan Finder.
2. Note which clients are in a contract with the high-performing (5-star) icon or the low-performing icon.
3. Compare each 2027 rating with the client's 2026 rating, and note big changes so you can explain them if asked.
4. For clients who have agreed to hear from you, schedule reviews, starting with LPI members.
5. Get the Scope of Appointment that CMS rules and your carriers require before any personal marketing appointment.
6. Run the needs analysis before you discuss ratings.
7. For any 5-star SEP move, check drug coverage and confirm the effective date with the carrier.
8. Pull or update materials that cite last year's ratings or a 5-star SEP that no longer applies.

What should you document?

Checklist (advice):

• Contract name and the 2027 rating the client saw, with the contract year
• Any high-performing or low-performing icon shown
• The client's doctors, drugs, and pharmacy, and how each option compared
• The election period used and why the client qualified
• The client's own reason for choosing or staying put
• For 5-star SEP moves, how the client will keep drug coverage
• The SOA and the call recording your carriers require

Ask your carriers and compliance team how long to keep each record.

Common mistakes

• Quoting a rating without "out of 5" or the contract year.
• Calling a contract "5-star" because one measure scored 5 stars.
• Treating stars as a plan-level score.
• Citing last year's ratings after October 8 without clearly labeling the contract year, or presenting them as current.
• Moving an MA-PD client to an MA-only 5-star plan without discussing Part D.
• Telling a client the 2027 ratings already reflect the 11 measure removals.
• Contacting members of low-performing plans who never asked to hear from you.

Tracking star ratings in LeadGPT

You can add custom fields to each lead record for the contract's 2027 rating and any LPI or 5-star flag. Calls you make or answer in LeadGPT are recorded, with a transcript and AI summary in the Call Log, and the AI Assistant can search those transcripts and update a lead's notes. Ask Sofia to set a reminder before November 30 for clients weighing a 5-star SEP move. Recording is always on with no announcement, so confirm disclosure rules with your compliance team. See the features overview or the interactive demo.

What to do next

1. Review every client's 2027 contract rating in Plan Finder.
2. Update scripts and materials to state ratings out of 5, with the contract year.
3. Mark November 30, 2027 as the last day of the 5-star SEP window for the 2027 plan year.
4. Point clients with SEP questions to 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048).

This guide is general information, not legal or compliance advice. Confirm each rule with CMS, your carriers or upline, and your compliance team. You'll find more guides in our insurance sales category, and our editorial policy explains how we research them.