CMS to Recalculate and Offer “Better Of” Star Ratings For 2026

研报英文原文证据摘录

CMS to Recalculate and Offer “Better Of” Star Ratings For 2026

Managed Care

CMS to Recalculate and Offer “Better Of” Star June 18, 2026

Ratings For 2026

●CMS To Recalculate All Contracts 2026 Star Ratings – Last Night, June 17th

CMS announced they would be recalculating and offering plans the “better of”

current or recalculated 2026 Star Ratings (Payment Year 2027) for all contracts.

This follows a recent court ruling in favor of Clover Health, where Clover alleged

that CMS improperly included 20 measures in the 2026 Star rating calculation, Justin Lake, CFA

which resulted in a Star rating decline from 4 Stars to 3.5 Stars in the co’s PPO jlake@wolferesearch.com

(646) 582-9280

plan covering a majority of its MA membership (see our recent work here). CMS View Justin’s Research

did note that yesterday’s announcement does not necessarily indicate similar View Comp Table

changes for 2027 as they appeal the Clover decision. Dillon Nissan

●We Recalc For Changes - Impact is Very Modest Here – Don’t See Any dnissan@wolferesearch.com

(646) 582-9281

Material Upside for Plans - We est. HUM and CVS may have modestly positive

impacts overall here with most others seeing none – in fact as illustrated by our Ben Tenner

btenner@wolferesearch.com

recalc below – many more contracts see a decline in Stars vs. improvement – (646) 582-9289

again fortunately CMS is providing “better of” so not a big deal here. In terms of

beneficiaries - HUM’s H1951 which represents ~2.7% of co membership would

see improvement from 4.0 Star to 4.5 Star and H4141 which represents 1.7%

of membership would go from 3.5 to 4.0 Star. For CVS, H4711 and H3928

both representing ~0.1%-0.2% of co membership would see star score improve

from 3.0 to 3.5 Star. Importantly the hold harmless provision in this CMS ruling