Profile and Financial Impact of Measures Dropped From Medicare Advantage Star Ratings

Category	Detail
Condition	Clinical topic addressed by the source article: Profile and Financial Impact of Measures Dropped From Medicare Advantage Star Ratings
Key Mechanisms	CMS eliminated 11 measures from the 2026 Star Ratings system; because 2 measures had separate Part C and Part D components, the study analyzed 13 removed measures and modeled changes in contract ratings, quality bonus payment eligibility, and payments.
Target Population	425 contracts and 29.0 million enrollees in the analytic cohort, after excluding contracts affected by disasters, below the post-removal minimum measure threshold, or without linkable enrollment data.
Care Setting	Care setting described in the source article.

Five of the 13 analyzed removed measures (38%) met the study’s definition of topped out; none of the 30 retained measures did.
After measure removal, ratings would decrease for 35.1% of contracts, remain unchanged for 62.6%, and increase for 2.4%.
The mean overall rating was modeled to decline from 3.58 to 3.41; the median remained 3.5.
Thirty-three contracts covering 2.6 million enrollees would lose quality bonus payment eligibility, while 6 contracts covering 239,560 enrollees would gain eligibility.
Modeled annual 2026 quality bonus payments decreased by $2.09 billion, or 13.9% of the $15.1 billion baseline pool.

Study definition: a measure was classified as topped out when its 10th-percentile contract attained at least 90% of maximum performance.

The study modeled ratings with and without removed measures; it did not evaluate or recommend clinical treatment.

Inputs included 2026 Star Ratings, May 2026 enrollment, and county-level benchmark rates.

In the model, 33 contracts lost and 6 gained quality bonus payment eligibility; annual payments decreased by $2.09 billion.
Five of 13 removed measures met the study’s topping-out definition; none of 30 retained measures did.

The analytic cohort represented 29.0 million Medicare Advantage enrollees across 425 contracts; 69% of contracts were HMOs and 30% were PPOs.

No patient-level treatment or prescribing was studied. The analysis assessed contract-level ratings and modeled financial effects.

Study methods: deterministic contract-level modeling, without statistical testing or patient-level clinical evidence.
The simulation recalculated reward-factor thresholds after measure removal while keeping the categorical adjustment index fixed at its 2026 value.
The analysis excluded contracts affected by disasters, those below the minimum measure threshold after removal, and those without linkable enrollment data.