Overview
- CMS finalized the 2027 Medicare Advantage and Part D rule Thursday, with an effective date of June 1 for coverage starting in 2027.
- The rule removes 11 star-rating measures and drops the planned Health Equity Index in favor of the historical reward factor, with most changes shaping 2029 scores and a new depression screening measure added.
- CMS projects the star-ratings overhaul will raise Medicare spending on plan bonuses by about $18.6 billion from 2027 through 2036.
- Part D drug coverage changes are now codified under the Inflation Reduction Act, including the end of the coverage gap, a $2,000 annual out-of-pocket cap, zero cost sharing in the catastrophic phase, and a manufacturer discount program.
- Supplemental benefits face new guardrails that require real-time debit card checks and exclude illegal cannabis products, and CMS rolled back several equity and administrative mandates while declining a proposed special enrollment period when providers leave plan networks.