CMS Releases CY 2027 Advance Notice: Key Considerations for Medicare Advantage Plans
CMS has released its CY 2027 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies. While the proposed updates reflect relative payment stability, they continue to reinforce CMS’s broader priorities around payment accuracy, data integrity, and quality measurement modernization.
Key Takeaways
If finalized, the proposed policies are projected to result in a net average year-over-year payment increase of 0.09%, representing more than $700 million in additional MA payments for CY 2027.
Beyond the topline payment impact, CMS’s proposals signal continued focus in several important areas:
- Greater payment accuracy and cost alignment, reinforcing CMS’s efforts to better match payments with beneficiary health status and underlying costs
- Ongoing updates to risk adjustment methodology, aimed at reducing administrative burden while refining model accuracy
- Star Ratings administrative updates, particularly affecting HEDIS-based measures transitioning to Electronic Clinical Data Systems (ECDS)-only reporting
Star Ratings: Quality Bonus Payment (QBP) Add-On
CMS proposes maintaining the current Quality Bonus Payment (QBP) structure applied to county benchmark rates:
STARS Quality Bonus Payment Percentage add-on to county rates*
| Star Rating | QBP Percentage |
|---|---|
| Fewer than 4 stars | 0% |
| 4.5, and 5 stars | 5% |
New MA plans and low-enrollment plans would continue to receive a 3.5% QBP.
How Advent Advisory Supports Plans
As CMS continues to modernize quality measurement and reporting expectations, Advent Advisory is working closely with health plans to navigate these changes.
For existing Medicare Advantage plans, we support:
- Aligning data sources and reporting workflows to fully enable ECDS-based HEDIS reporting
- Strengthening data governance and validation processes to support quality performance under evolving requirements
For organizations new to Medicare Advantage, we help:
- Interpret reporting and submission requirements
- Identify and assess eligible data sources that can support HEDIS ECDS reporting from the outset
- Establish scalable reporting frameworks aligned with CMS expectations
Looking Ahead
While the CY 2027 Advance Notice reflects modest payment growth, it underscores CMS’s continued emphasis on data-driven accuracy, quality modernization, and operational readiness. Plans that invest early in aligning data, reporting, and quality infrastructure will be better positioned as these proposed policies move toward finalization.
Advent Advisory remains committed to helping health plans translate regulatory change into practical, sustainable execution.
Advent Advisory Group Insights
