Each year, Medicare Stars cut points continue to rise, and 2026 is no exception. Nearly 60% of all cut points increased year over year, including approximately 60% of 4-Star thresholds, further reinforcing how challenging it has become to achieve and sustain high performance. As expectations continue to climb, plans must shift from reactive adjustments to long-term strategies designed to withstand an increasingly demanding Stars environment.
Rather than preparing for 2026, health plans are now navigating it in real time. While understanding these changes is important, the bigger opportunity lies in planning for the future, because the strategies you put in place today will shape your performance for 2027 and beyond.
Medicare Stars operate on a multi-year timeline: the ratings CMS publishes, and the bonuses plans receive, are based on member experience, clinical outcomes, and adherence patterns from prior measurement years. Because of this lag, by the time we enter a new Stars cycle, most of the performance year is already determined. That’s why, even though we’re now in the 2026 Stars year, the measures influencing those ratings are largely set, and the window to meaningfully shift performance has already passed. While it’s still important to understand what’s changing in 2026, the greatest opportunity for improvement comes from looking ahead, strengthening long-term strategies now to elevate performance for 2027 and beyond.
Here’s what’s happening in 2026, what it means for your plan, and why shifting your focus forward is the smartest move you can make.
What’s Happening in 2026 Stars Ratings
Cut Points Across the Board
- Wakely analysis shows that 63% of 4-Star cut points are harder to reach in 2026 compared to 2025.
- Overall, 57% of cut points increased, with major jumps in 2-, 3-, and 4-Star thresholds.
Translation: If you didn’t already prepare for these increases, you’re now playing on a steeper hill, and future planning is critical to avoid repeating the same pressure in 2027.
Measure Weight Shifts & New Additions
- For 2026, CMS:
- Cut the weighting for Patient Experience / Complaints and Access measures from 4x to 2x.
- Introduced three new Part C measures: 1. Kidney Health Evaluation for Patients with Diabetes, 2. Improving or Maintaining Physical Health, 3. Improving or Maintaining Mental Health
- Kept outcome and intermediate outcome measures, including diabetes control and blood pressure control, at 3x weighting.
These shifts reinforce the long-term trend: outcomes and chronic condition management will continue to dominate the Stars landscape.
Part D: Temporary Weight Drops, But Only for 2026
Medication adherence measures for diabetes, hypertension, and high cholesterol drops from triple weighted (3x) to single weighted (1x) in 2026 to allow for the necessary implementation of sociodemographic status (SDS) risk adjustments, but the full weighting is expected to return in 2027.
This is not the year to take your foot off the gas. Plans that allow adherence performance to slip now will face a steeper recovery later.
Increasing Importance of Pharmacy & Adherence Performance
Pharmacy and HEDIS-related measures saw some of the largest cut-point increases year over year, reinforcing that these are, and will remain, core drivers of Stars success.
2026 is simply making that reality more visible.
What This Means for Health Plans
Because the 2026 structure is already defined, health plans should view this year as a diagnostic moment. How you perform today gives you insight into:
- Gaps you must close ahead of 2027
- Adherence vulnerabilities that will matter even more when weighting increases
- Clinical outcomes that require multi-year strategies, not short-term tactical fixes
The most important takeaway is this:
2026 performance is the result of 2024–2025 strategies. 2027 performance will be the result of what you do now.
How PlanPlus Positions Health Plans for Long-Term Stars Success
Even though 2026 is underway, PlanPlus helps health plans stay on track now while building the foundation for the higher-stakes performance years ahead.
- PersistRx – Maximizing Member Adherence: RN-led, relationship-driven adherence support helps stabilize Stars-critical measures and protects performance as weights fluctuate.
- Impensacare – Reducing Total Cost of Care: High-cost-claimant management and preventive support reduce the clinical and financial burdens that drag Stars performance down.
- Curalytics® SONAR – Actionable, Real-Time Insights: Dashboards, alerts, and analytics help plans identify risks early and intervene months, not weeks, before cut points are affected.
- Longitudinal Care Management: Sustained, year-round support ensures that improvements last beyond the current Stars cycle.
What Health Plans Should Prioritize Going Forward
- Focus on Long-Term Triple-Weighted Measures: Even though adherence measures dropped to 1x for 2026, they will return to full weighting in 2027. Consistency now protects your future rating.
- Engage Members Proactively: Personalized outreach and RN-led coaching strengthen the member relationships that lead to higher adherence and better outcomes.
- Use Real-Time Data to Guide Rapid Intervention: Live monitoring of refill gaps and clinical trends allows your teams to act before erosion in performance becomes irreversible.
- Invest in Multidisciplinary Teams: Pharmacists, nurses, social workers, and medical assistants each solve different barriers, and long-term Stars success requires all of them working together.
The Bottom Line: 2026 Is Already Set, Your Strategy Should Be Focused on 2027
While understanding the 2026 changes is essential, this year’s structure is already locked in. The real opportunity is in forward planning, particularly with outcomes, adherence, and chronic condition measures becoming even more central to Stars success.
PlanPlus is your strategic partner not just for navigating the current landscape but for building the multi-year stability needed to stay ahead of rising cut points and shifting weights.