CMS' Decision to Recalculate 2026 Stars / 2027 Bonus Year is an Upside Only Scenario for Payors

研报英文原文证据摘录

CMS' Decision to Recalculate 2026 Stars / 2027 Bonus Year is an Upside Only Scenario for Payors

Healthcare Services

EQUITY RESEARCH Industry Report

June 18, 2026

CMS' Decision to Recalculate 2026 Stars / 2027 Bonus

Research Analysts:

Sarah James Year is an Upside Only Scenario for Payors

212-829-5203

Sarah.James@cantor.com CMS is creating an upside only scenario for MA payors, in our view, by

Gabie Ingoglia recalculating 2026 Stars / 2027 Bonus Year. In an HPMS memo distributed

212-610-2238 directly to plans last night (6/17/26), CMS shared it will recalculate 2026 Gabie.Ingoglia@cantor.com

Stars / 2027 Bonus Year using only HEDIS, CAHPS, and HOS measures. If

the recalculation drove a lower bonus payment, plans will not receive an

updated rating which eliminates downside risk from this decision. CMS'

action is prompted by the decision in Clover (CLOV, NC) vs. HHS issued

on 5/27/26 where the court ruled CMS unlawfully included 20 arbitrary

measures in Clover's 2026 MA Star rating calculation.

We estimate 6/6 public payers (HUM, CVS, UNH, ELV, CNC, MOH) averaged

a sub-4 rating on the removed metrics, implying a benefit from the

recalculation. Our initial estimates show the metrics removed by the

decision were dragging down overall Stars ratings on a raw average basis.

We acknowledge metric weights & other actuarial elements could disrupt

our calculations assumptions, but recent conversations with 2 major payors

earlier this week agree with our take that this outcome is positive.

●Removed metrics are: all Part D Measures & Part C Measures of special

needs plan care management, complaints about the health plan,

members choosing the leave the plan, plan makes timely decisions

about appeals, reviewing appeals decisions, and call center - foreign