Last Updated: April 21, 2026
On April 2, 2026, CMS issued a final rule that updates the Medicare Advantage (MA) and Part D prescription drug programs for contract year (CY) 2027. The rule includes changes to:
- MA Star Ratings
- Special enrollment periods (SEPs)
- Non-allowable supplemental benefits for chronically ill beneficiaries
- Reduction of plans’ administrative burden
- Codification of provisions of the Inflation Reduction Act of 2022 (IRA)
The most significant changes for plans and providers are related to Star Ratings. The finalized changes will increase payments to plans by $18.6 billion over 10 years and could limit the effectiveness of the provider complaint process CMS revised in 2024.
The rule is extensive and addresses many aspects of the MA program. Below is a summary of select provisions that will impact health plans and providers.
Medicare Advantage & Part D Star Ratings
CMS administers a five-star rating system for MA (Part C) and Part D plans to provide beneficiaries with comparative quality information and determine bonus payments and rebates. CMS continues to refine the Star Ratings system in alignment with its national quality strategy and finalizes several changes in the CY 2027 rule.
Measure Removals
CMS streamlines the Part C and Part D Star Ratings program by removing 11 measures beginning with the CY 2029 Star Ratings year. CMS does not finalize the proposed removal of the Diabetes Care—Eye Exam measure, which will remain in the Star Ratings program. The measure removals will apply for the 2027 measurement period and the 2029 Star Ratings, except for the Call Center—Foreign Language Interpreter and TTY Availability (Part C and D) measures and the Statin Therapy for Patients with Cardiovascular Disease (Part C) measure, which will apply beginning with the 2028 Star Ratings.
CMS contends these measures often show consistently high performance with little variation across contracts, making them less meaningful for beneficiaries when comparing plans. By eliminating measures that are “topped out” or sensitive to small changes, the agency aims to reduce administrative burden and increase the relative weight of outcome-focused measures. The changes are intended to shift attention toward clinical care, outcomes, and patient experience measures where improvement is still needed. In the final rule, CMS also states it will not implement the Health Equity Index and will continue to include the historical reward factor in the Star Ratings methodology.
Measure Addition
CMS finalizes the addition of the Depression Screening and Follow-Up (DSF) measure starting with the 2027 measurement year, which will impact CY 2029 Star Ratings.
Special Enrollment Periods
CMS proposed two changes to special enrollment periods (SEPs).
- Provider Leaving Plan Network: CMS does not finalize its proposal to allow any enrollee who has recently received care from a terminated provider to automatically qualify for an SEP.
- Prior Approval for SEPs: CMS codifies its policy that certain SEPs require prior approval from CMS before an election request can be processed. SEPs affected by this include those for contract violations, CMS sanctions, loss of creditable coverage, and other exceptional circumstances. Eligibility for these SEPs will be confirmed either through a CMS-operated mechanism, such as 1-800-MEDICARE or the Online Enrollment Center, or via an official CMS notice.
Non-Allowable Special Supplemental Benefits for Chronically Ill Enrollees
CMS clarifies that cannabis products that are illegal under applicable federal or state law, including those restricted by the Federal Food, Drug, and Cosmetic Act, cannot be offered as Special Supplemental Benefits for the Chronically Ill (SSBCI). However, MA plans are permitted to offer certain food ingredients derived from hemp seeds as SSBCI if they meet the Food and Drug Administration’s “generally recognized as safe” standard and demonstrate health benefits.
Reducing Administrative Burden for MA Plans
CMS proposed to remove requirements that are duplicative or are no longer applicable, including:
- Exempting Account-Based Medical Plans From Entities Required to Make Disclosures of Creditable Coverage: CMS finalizes that account-based plans, such as health reimbursement arrangements (HRAs) and individual coverage health reimbursement arrangements (ICHRAs), are exempted from group health plans that are required to make creditable coverage disclosures.
- Deregulating Section 422.102(e) Pathway for Certain Dual Eligible Special Needs Plans (D-SNPs) to Offer Supplemental Benefits: Section 422.102(e) currently allows certain D-SNPs to offer additional supplemental benefits. CMS noted in the proposed rule that very few plans used this pathway and the same benefits can already be provided under existing rules. As such, the agency proposed eliminating §422.102(e) to streamline the bid submission process. However, after considering comments, CMS does not finalize this proposal and retains §422.102(e) as a pathway for D-SNPs to offer supplemental benefits.
- Rescinding the Mid-Year Supplemental Benefits Notice: CMS finalizes its proposal to rescind the mid-year notice requirement related to supplemental benefits, concluding that it does not improve communication with beneficiaries and is an unnecessary administrative burden. The agency contends that existing outreach and care coordination efforts already ensure enrollees are aware of and use supplemental benefits effectively.
- Revising the Ensuring Equitable Access to Medicare Advantage (MA) Services Requirement: CMS finalizes its proposal to revert §422.112(a)(8) to its original heading and text, “Cultural considerations,” which requires MA plans to provide services in a culturally competent manner to all enrollees.
- Rescinding the Annual Health Equity Analysis of Utilization Management Policies and Procedures: CMS finalizes its proposal to rescind the requirements that MA utilization management committees include a member with expertise in health equity, conduct an annual health equity analysis of prior authorization, and publicly post that analysis. The agency contends these provisions create unnecessary regulatory burden, do not significantly improve health equity, and are inconsistent with recent executive orders.
- Rescinding the Quality Improvement Program Health Disparities Requirement: CMS eliminates the requirement that MA plans include activities to reduce health disparities in their quality improvement (QI) programs.
- Deregulating the Special Rule for Non-Compliant D-SNPs: The Balanced Budget Act of 2018 authorized the Secretary of Health and Human Services to impose an enrollment sanction on an MA plan offering a D-SNP that has failed to meet at least one of the new integration standards in plan years 2021 through 2025. In the final rule, CMS removes this provision, given that the statutory authority for the enrollment sanction expires at the end of plan year 2025.
Codifying Inflation Reduction Act Provisions
CMS codifies reforms from the IRA. These changes are significant and include eliminating the coverage gap, lowering out-of-pocket thresholds, removing catastrophic phase cost sharing, and implementing the Manufacturer Discount Program.
How Forvis Mazars Can Help
Forvis Mazars helps MA plans and other payors achieve regulatory excellence to strategically navigate the evolving policy environment. If you have questions about the CY 2027 MA final rule and how it may affect your organization, please reach out to our professionals.