On April 2, 2026, the Centers for Medicare and Medicaid Services finalized the contract year 2027 Medicare Advantage rule. Among the changes receiving the least attention — but deserving the most scrutiny from beneficiaries — is a significant restructuring of the Medicare star ratings system.
Starting with the 2027 measurement period and the 2029 Star Ratings, CMS is removing 11 measures from the star ratings calculation. Several of these measures tracked how well Medicare Advantage plans handled complaints, appeals, and grievances from their own members.
As a registered nurse who spent 13 years in clinical settings — including neurology, surgical, hospice, and VA care — I have seen what happens when a Medicare Advantage plan denies a claim, delays a prior authorization, or stonewalls a grievance. I have sat with patients and families navigating those processes. The idea that a plan’s track record on complaints and appeals will no longer factor into its publicly visible quality score is something Kansas City area beneficiaries need to understand before the 2027 Annual Enrollment Period opens this October.
What Are Medicare Star Ratings?
Medicare star ratings are CMS’s public quality scoring system for Medicare Advantage and Part D drug plans. Plans are rated on a scale of one to five stars across multiple categories including preventive care, management of chronic conditions, member experience, customer service, and drug plan performance.
Star ratings matter for several reasons. They help beneficiaries compare plan quality on medicare.gov. They affect carrier revenue — higher-rated plans receive bonus payments from CMS. And they influence where beneficiaries enroll, since five-star plans can be marketed more aggressively and have special enrollment privileges.
For Kansas City area beneficiaries choosing between multiple Medicare Advantage plans available in Jackson County, Johnson County, or Clay County, star ratings have been one of the few standardized quality signals available. A plan with four or five stars theoretically performed better across a range of quality measures than a plan with two or three stars.
What Measures Are Being Removed?
CMS is removing 11 measures from the star ratings calculation, citing a desire to “simplify and refocus” the measure set and reduce administrative burden. The specific measures being removed include several that tracked plan performance on complaints, appeals, and grievances filed by members.
These are not obscure administrative metrics. Complaints and appeals data reflects real beneficiary experiences — how often members filed grievances against their plan, how often prior authorization requests were denied, how often those denials were overturned on appeal, and how quickly plans resolved member complaints.
A Medicare Advantage plan with a high complaint rate or a high prior authorization denial rate that gets frequently overturned on appeal was penalized in its star rating under the old system. Starting with the 2029 Star Ratings — which will reflect 2027 plan performance — that penalty disappears.
CMS’s stated rationale is that the existing broad quality measures already capture plan performance adequately, and that these specific administrative measures create burden without meaningfully differentiating plan quality. Several commenters on the proposed rule strongly disagreed, warning that removing these measures would reduce transparency around one of the most consequential aspects of plan performance for beneficiaries with complex health needs.
Why Prior Authorization and Complaints Data Matters
This is where my clinical background informs my perspective in a way that goes beyond what most Medicare advisors can offer.
Prior authorization is the process by which a Medicare Advantage plan requires advance approval before covering certain services, procedures, medications, or specialist referrals. Under Original Medicare, prior authorization is rarely required. Under Medicare Advantage, it is common — and the denial of a prior authorization request can delay or prevent access to care that a physician has determined is medically necessary.
I have worked with patients in Blue Springs, Independence, and throughout the Kansas City metro who faced prior authorization denials for chemotherapy, surgical procedures, skilled nursing facility stays, and home health services. The appeals process is real, it is stressful, and it takes time that patients and families often do not have.
A plan’s complaints and appeals track record is one of the most clinically meaningful signals available about how that plan actually operates in the real world — not how it performs on preventive screening rates, but how it behaves when a sick patient needs care that the plan finds expensive.
Removing these measures from star ratings does not mean plans will suddenly start denying more claims. But it does mean that a plan’s track record on denials and complaints will no longer be visible in the quality score that most beneficiaries use to evaluate plans.
What This Means for Kansas City Area Beneficiaries in 2027
The 2029 Star Ratings — which will reflect 2027 plan year performance — will not include complaints and appeals measures. For beneficiaries enrolling during the October 2026 Annual Enrollment Period, that change does not yet affect the ratings they will see. The 2027 Star Ratings, which will be used during the fall 2026 enrollment period, still reflect the old measure set.
But here is what matters right now: if you are evaluating Medicare Advantage plans this fall using star ratings as a quality signal, you should understand that those ratings already have limitations — and those limitations are about to grow.
Star ratings measure what CMS has chosen to measure. They have never been a complete picture of plan quality from a beneficiary perspective. The removal of complaints and appeals measures makes them less complete, not more.
How to Evaluate Medicare Advantage Plan Quality Beyond Star Ratings
Given these changes, here is how I recommend Kansas City area beneficiaries think about plan quality when evaluating Medicare Advantage options for 2027:
Check the plan’s prior authorization requirements. Every Medicare Advantage plan publishes a list of services requiring prior authorization. Plans vary significantly in how broadly they apply prior authorization requirements. A plan that requires prior authorization for specialist visits, imaging, outpatient procedures, and most prescription drugs will create more friction in your care than a plan with more limited prior authorization requirements.
Review the plan’s Appeals and Grievances data on medicare.gov. Even though these measures are being removed from the star ratings calculation, CMS still publishes raw complaints and appeals data on the Medicare Plan Finder at medicare.gov. You can look up how many complaints were filed against a specific plan and how often prior authorization denials were overturned on appeal. This data will still be available — it just won’t be baked into the star rating anymore.
Ask about the plan’s coverage determination process. When I review plans with Kansas City area clients, I ask specifically about how the plan handles prior authorization for the services most relevant to that client’s health situation. A client managing cancer, heart disease, or a neurological condition has very different prior authorization exposure than a healthy 65-year-old with no chronic conditions.
Consider Original Medicare with a Medigap supplement. Under Original Medicare, prior authorization is rarely required. A Medigap Plan G covers Medicare’s cost-sharing gaps with no network restrictions and no prior authorization requirements. For beneficiaries who are managing complex health conditions or who have had prior authorization problems with Medicare Advantage plans in the past, the switch to Original Medicare with a supplement deserves serious consideration — even if the monthly premium is higher.
The Broader Context: Star Ratings Are a Tool, Not the Answer
I want to be clear about something. Star ratings have never been the right way to choose a Medicare Advantage plan for your specific situation. They are a useful starting point — a way to screen out plans with consistently poor quality — but they have always been a blunt instrument.
The right way to choose a Medicare Advantage plan is to verify your specific doctors are in-network, check your specific medications on the formulary, model your likely annual costs based on your health situation, and understand the plan’s prior authorization requirements for the services you actually use. None of that information comes from a star rating.
What concerns me about removing the complaints and appeals measures is not that beneficiaries will suddenly stop being able to make good plan choices. It is that one more piece of publicly visible accountability disappears from a system that already lacks transparency in ways that matter to sick people.
I have been on the clinical side of these coverage disputes. I have seen the human cost of prior authorization delays and denials. The data that tracked how often plans put their members through that process deserved to stay in the public quality scorecard.
What You Should Do Before Open Enrollment This Fall
The Annual Enrollment Period opens October 15, 2026. Here is what I recommend for Kansas City area Medicare beneficiaries evaluating plans under the new star ratings framework:
Do not rely on star ratings alone. Use them as one signal among several, not as the primary basis for a plan decision.
Visit medicare.gov and look up the specific plans available in your ZIP code. Review not just the star rating but the underlying complaints and appeals data that will still be published even after it is removed from the rating calculation.
If you are currently on a Medicare Advantage plan and have experienced prior authorization denials, coverage disputes, or complaints that were difficult to resolve, this is worth discussing with an independent advisor before the next enrollment period.
Call me at 816-291-3655 or schedule a free consultation. I serve beneficiaries throughout the KC metro — from Overland Park and Olathe in Johnson County Kansas to St. Joseph and Liberty in north Missouri — and I pull the actual plan data for your specific ZIP code and health situation before making any recommendation.
Frequently Asked Questions
What are Medicare star ratings and why do they matter?
Medicare star ratings are CMS’s public quality scoring system for Medicare Advantage and Part D plans, rated one to five stars. They measure plan performance across preventive care, chronic condition management, member experience, customer service, and other categories. Higher-rated plans receive bonus payments from CMS and are often marketed more aggressively. They help beneficiaries compare plan quality on medicare.gov but have always been a limited measure of what matters most to individual enrollees.
Which measures are being removed from Medicare star ratings in 2027?
CMS is removing 11 measures from the star ratings calculation starting with the 2027 measurement period and reflected in the 2029 Star Ratings. Several of the removed measures tracked plan performance on complaints, appeals, and grievances filed by members. The specific measures being removed include administrative process measures where CMS determined there was high performance and little variation between plans.
Will complaints and appeals data still be available to beneficiaries?
Yes. CMS will continue to publish raw complaints and appeals data on the Medicare Plan Finder at medicare.gov even after those measures are removed from the star ratings calculation. The data will still be there — it just will not be factored into the overall star rating score that most beneficiaries use to compare plans.
Does a high star rating mean a plan won’t deny my claims?
No. Star ratings measure performance across a broad range of categories. A plan with a high star rating can still have aggressive prior authorization requirements and a meaningful prior authorization denial rate. Before enrolling in any Medicare Advantage plan, I recommend reviewing the plan’s prior authorization policies for the services most relevant to your specific health situation.
Should I switch from Medicare Advantage to Original Medicare because of these changes?
Not necessarily — but it is worth a conversation if you are managing complex health conditions, have experienced prior authorization problems, or value provider freedom over premium savings. Original Medicare with a Medigap supplement has no prior authorization requirements and no network restrictions. Whether the switch makes financial sense depends on your specific situation. Call me for a free review at 816-291-3655.