Federal regulators released the hotly anticipated star ratings for the 2027 Medicare Advantage plan year. Winners and losers have emerged in the data.
The Centers for Medicare & Medicaid Services released the rankings data late Thursday, saying that 71% of Medicare Advantage enrollees overall are in plans that earned at least four stars for 2027.
One of the biggest risers of the year is Humana, which reverses a significant drop-off in 2025 and 2026. The insurer had 25% of enrollees in a plan with four or more stars in 2025, with that number declining further to 20% in 2026. However, for 2027, that percentage jumps to 93%, just shy of its 94% tally in 2024, according to a report from analysts at Stephens.
Four or more stars is the ideal threshold to secure "lucrative" quality bonus payments, analysts at Capstone said. For Humana, its four largest plans, which together include about 68% of its total Medicare Advantage book, all scored at least four stars. The researchers rated the shift as positive for the company.
"Capstone believes Humana is the clear winner among major MA plan carriers," the analysts wrote.
The Stephens analysts echoed the sentiment, highlighting the company's rebound from two low performance years in a row.
Clover Health also notches a significant win in the 2027 rankings, with the number of members in a plan with four or more stars jumping from just 3% in 2026 to 100% in 2027, per Stephens.
Clover's star ratings performance has yo-yoed over the past several years, with 0% of its enrollees in plans with four or more stars in 2024, then 96% in 2025.
Clover is at the center of an ongoing lawsuit that led to score recalculations across the board for 2026. In that ruling, a federal judge set aside about 20 metrics that were used to calculate Clover's scores, and other insurers sought to follow suit and see their performance calculated in line with the lawsuit's parameters.
The federal government has appealed that ruling, so the case is ongoing. The Capstone analysts said that they would expect payers that saw drop-offs in 2027 to seek similar legal avenues.
"As this case remains on appeal, we expect any plans that saw material losses in star ratings this year to litigate and seek recalculation under the Clover Health standard, which saw 20 measures struck from calculations," they wrote.
Capstone also rated the star ratings results as "slightly positive" for Elevance Health, which saw a slight decline in its overall performance during the year. Stephens found that 45% of the company's members are in plans with four or more stars for 2027, down from 53% in 2026.
The Capstone report said that the star ratings performance would likely be neutral for both Centene and UnitedHealthcare. Centene has been consistent in low performance in the star ratings over the past several years, with just 1% of its members in plans with at least four stars in both 2024 and 2025.
That figure grew to 18% in 2026 before falling again to 9% in 2027, according to the Stephens report.
UnitedHealthcare, meanwhile, will have about 67% of its members in plans with at least four stars for 2027, decreasing from 78% in 2026. Sixty-nine percent of UHC's Medicare Advantage members were in high-scoring plans in 2025, as were 80% in 2024.
The Capstone analysts consider the star ratings results as a negative for CVS Health's Aetna, as three of the insurer's four largest contracts saw their scores decline for the coming year, representing about 33% of its total MA book. Two of those plans fell below four stars, according to the report.
Stephens, meanwhile, called out Alignment Healthcare's results, with the number of members in plans with at least four stars plummeting year over year.
At Aetna, 69% of its members are set to be in plans with four or more stars for 2027, down from 81% in 2026, according to Stephens. The insurer held steady at 87% in 2025 and 2024.
Aetna's star ratings performance in recent years reflects a significant turnaround in 2024, as in the 2023 scores, just 21% of its members were in plans earning at least four stars. It was particularly dinged by a one-score decrease for its National PPO Plan, which at the time accounted for more than half of its total MA enrollment.
At Alignment, just 25% of its members will be enrolled in plans with at least four stars for 2027, according to the Stephens report. That's a significant drop off from having 100% of its members in high-performing plans in both 2025 and 2026. Ninety percent of Alignment members were in plans with four or more stars for 2024.
The Stephens analysts note that Alignment's California HMO decreased by half a star to a 3.5 score, dragged down by two metrics from the Health Outcomes Survey that were weighted three times in the 2027 scores.
With the latest scores out, insurers will now be preparing for any changes that could be implemented for the 2028 scores. In the Capstone report, the analysts said that CMS has been working to align the star ratings with the Universal Foundation, a quality measurement framework that includes just 10 metrics pulling from Healthcare Effectiveness Data and Information Set (HEDIS) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) data.
For instance, CMS deleted 11 measures for the 2027 calculations, with the metrics set to be phased out by 2029. These measures were tied to administrative processes rather than member outcomes, CMS ruled.
"We expect CMS to further reduce star rating measures in the CY28 Policy and Technical Changes Rule—a negative for plans that have historically been able to capitalize on administrative efficiencies to score highly on 'back office' measures rather than measures directly related to patient outcomes," the Capstone analysts said.
Open enrollment for Medicare begins on Oct. 15.