Humana told the SEC on October 9 that the 2027 Star Ratings CMS had posted a day earlier put it past its Top Quartile goal, and the CMS fact sheet behind that filing shows how one carrier can win in a year the headline count fell. 188 MA-PD contracts, about 37%, earned four stars or better, down from 229, while the enrollment-weighted share of members in those contracts rose to 70.73% from 67.16% (CMS, October 8, 2026).
The two columns of Table 1 settle different money. The contract count is what the trade press reported. The enrollment column is what a 2028 bid carries: 70.73% of MA-PD membership now sits in contracts that add 5 percentage points to their benchmark, while the share at 4.5 stars or better, where the rebate is 70% of savings against 65% a half-star lower, fell from 41.21% to 34.95%.
Key Takeaways
- 188 of 508 MA-PD contracts (37.0%) earned four stars or better for 2027, from 229 of 516 (44.4%) in the restated 2026 column; the enrollment-weighted average rating slipped to 3.99 from 4.01, and five-star contracts fell to 15 from 22, six of them repeats.
- 70.73% of MA-PD enrollment (2.25% at five stars, 32.70% at 4.5, 35.78% at 4.0) sits in contracts that earn the 5% benchmark bonus for 2028, up from 67.16%: the contracts that fell out were small and the ones that landed at 4.0 were large.
- 6.26 points of enrollment left the 4.5-star-or-better tier, from 41.21% to 34.95%; on a $320 per member monthly savings, the move from a 70% to a 65% rebate share costs $16 a month, $192 a year, and $19.2 million on a 100,000-member contract.
- 22 contracts and 2.8 points of enrollment were added to the 2026 four-star group between the October 2025 fact sheet (207 contracts, 64%) and the restated column (229, 67.16%) by the June 2026 quality bonus recalculation; against the original base, the 4.5-star slide is 3.2 points.
- 93% of Humana's members are in four-star-or-better plans for 2027, from 41%, which TD Cowen puts at $3 billion or more of 2028 revenue, while UnitedHealth, CVS, Elevance, Centene and HCSC each have fewer and Alignment fell from 98% to 25%.
Table 1: 508 Contracts, 15 at Five Stars, and 788,000 Members Behind the Icon
CMS rated 508 MA-PD contracts for 2027 on up to 43 measures, after 516 in 2026, 521 in 2025 and 545 in 2024, and the enrollment-weighted average rating ran 4.07, 3.95, 4.01 and 3.99 across those four years. Fifteen contracts carry the five-star high-performing icon, down from 22, six of them repeats, and four carry the low-performing icon, the same count as last year. CMS's framing of the swing is one sentence: "Changes in Star Ratings year-over-year are normal and expected and vary by measure" (CMS, October 8, 2026).
Appendix A1 gives the five-star group its scale. The 15 contracts hold 787,962 members as of October 2026, and MCS Advantage's H5577 in Puerto Rico holds 360,519 of them, 46% of the tier on its own. Clover's H5141 adds 155,135 and Triple-S's H5774 another 120,943, so three contracts hold 81% of five-star enrollment. UnitedHealth's three five-star contracts together hold 61,107 members and Longevity Health's five hold 5,187. The 2.25% of enrollment at five stars is mostly a Puerto Rico and Clover figure.
| Overall rating | 2026 contracts | 2026 enrollment share | 2027 contracts | 2027 enrollment share | 2028 benchmark bonus | Rebate share |
|---|---|---|---|---|---|---|
| 5 stars | 22 | 2.43% | 15 | 2.25% | +5 pts | 70% |
| 4.5 stars | 89 | 38.78% | 65 | 32.70% | +5 pts | 70% |
| 4 stars | 118 | 25.95% | 108 | 35.78% | +5 pts | 65% |
| 3.5 stars | 166 | 25.50% | 164 | 19.71% | none | 65% |
| 3 stars | 98 | 6.82% | 124 | 8.75% | none | 50% |
| 2.5 stars and below | 23 | 0.52% | 32 | 0.82% | none | 50% |
| Total rated | 516 | 100% | 508 | 100% |
Source: CMS, 2027 Medicare Advantage and Part D Star Ratings fact sheet, Table 1 (October 8, 2026). The 2026 column is as restated in that sheet after the June 2026 quality bonus payment updates. Benchmark bonus per 42 CFR 422.258(d), before the qualifying-county doubling and the pre-ACA cap; rebate share per 42 CFR 422.266(a)(2).
Tables 3 and 5 read differently under the two weightings as well. Some 44% of nonprofit contracts reached four stars against 34% of for-profit ones, yet weighted by enrollment the gap narrows to 73.6% against 69.9%. The largest for-profit contracts sit at 4.0 stars (37.26% of for-profit enrollment) and the largest nonprofit ones at 4.5 (42.64%). Contracts with ten or more years in the program reached four stars 42.4% of the time, those under five years 29.8%. Among standalone PDPs, 11 of 41 contracts and 22% of enrollees reached four stars, from 2% of enrollees in 2026, with no five-star PDP and 51.27% of PDP enrollment at three stars.
The Half-Star Between the 70% and 65% Rebate Tiers
The regulation splits the two columns' money. Under 42 CFR 422.258(d), a contract rated four stars or higher adds 5.0 percentage points to the applicable percentage that sets its benchmark, doubled in qualifying counties and capped at the pre-ACA applicable amount. Under 42 CFR 422.266, the share of benchmark-to-bid savings returned as rebate is 70% at 4.5 stars or higher, 65% from 3.5 to below 4.5 and 50% below 3.5. The 2027 ratings fix both for the 2028 payment year. A contract that slid from 4.5 to 4.0 kept the benchmark lift and gave up five points of rebate share.
MedPAC projects the average 2026 rebate across non-employer plans at $222 per member per month, about $2,660 a year and 15% of total MA payments (MedPAC, March 2026). At that scale, a contract whose bid sits $320 below its benchmark earns $224 of rebate at 4.5 stars and $208 at 4.0. The half-star costs $16 a month, $192 a member a year, and $19.2 million on a 100,000-member contract, taken from the pool that funds supplemental benefits, the Part D buydown and cost-sharing reductions. Across the 6.26 points of enrollment that left the 4.5 tier, that is the 2028 cut before the benchmark moves at all.
The flows in Table 1 say which contracts moved. The 4.5 tier lost 24 contracts and 6.08 points of enrollment; the 4.0 tier lost 10 contracts yet gained 9.83 points; the 3.5 tier lost 2 contracts and 5.79 points. Large contracts entered 4.0 from both directions, down from 4.5 and up from 3.5, and the contracts leaving 4.0 downward were small. Carrier reporting confirms the split. Humana's share of members in four-star-or-better plans went from 41% to 93%, while UnitedHealth, CVS, Elevance, Centene and HCSC each have fewer. Alignment fell from 98% to 25% when its largest contract dropped below four stars (Healthcare Dive, October 9, 2026).
Humana's 8-K defines the win as "Stars revenue per member per month (PMPM) 10% above the peer group median" (Humana, October 9, 2026), which TD Cowen's Ryan Langston put at $3 billion or more of 2028 revenue. The same two carriers set where the bonus is paid: KFF counts UnitedHealth exiting 228 counties and entering 9, Humana exiting 62 and entering 4, and 193 counties with no general-enrollment MA-PD, up from 123 (KFF, October 9, 2026). The site's August read of the $13.4 billion quality bonus had the qualified base at 68%; 2027 puts it at 70.73%, with the dollars moving from UnitedHealth's book to Humana's.
How Much of the 229-to-188 Fall Is the Measure Set and the Restated Base
The 2027 measure set differs from the one that produced 229. Two Part D measures entered, Concurrent Use of Opioids and Benzodiazepines at an average 3.5 stars and Polypharmacy anticholinergic use at 3.3. Care for Older Adults Functional Status Assessment returned after respecification, and the respecified Colorectal Cancer Screening replaced the legacy measure, its average falling from 3.8 to 3.4. Pain Assessment and Medication Reconciliation Post-Discharge retired. The Improving or Maintaining Physical Health and Mental Health measures went from a weight of one to three, at averages of 3.0 and 3.2. Extreme and uncontrollable circumstances adjustments applied for the California wildfires and Texas storms of the 2025 performance period.
Tables 7 and 8 show which measures carried the averages. Plan All-Cause Readmissions rose from 2.9 to 3.4 and Transitions of Care from 3.1 to 3.4. MPF Price Accuracy fell from 4.6 to 4.2, Medication Adherence for Diabetes from 3.1 to 2.7 and Controlling Blood Pressure from 3.4 to 3.0. Timely Appeals fell from 4.1 to 3.9 after CMS began applying scaled reductions where Independent Review Entity data were incomplete. A contract near the four-star line with weak adherence and appeals scores moved on measures CMS left alone, and the fact sheet supplies no decomposition of the 41-contract decline between measure-set change and performance.
The baseline moved too. The October 2025 fact sheet reported 207 contracts, about 40%, at four stars or better for 2026, with 64% of enrollees and an average rating of 3.98 (CMS, October 2025). The 2027 sheet's 2026 column reads 229 contracts, 67.16% and 4.01, because it reflects contracts "that had their 2027 Quality Bonus Payment rating updated in June 2026" after the Clover ruling forced a recalculation that struck 20 measures. Four contracts were added at five stars, 16 at 4.5 and two at 4.0: 22 contracts and 2.8 points of enrollment entered the four-star group by recalculation.
Against the base CMS published a year ago, the contract count fell by 19, to 188, and the four-star enrollment share rose 6.4 points, from 64.36% to 70.73%. The 4.5-star-or-better share fell 3.2 points, from 38.11% to 34.95%, half the 6.26-point slide measured against the restated column. Half the rebate-tier loss a 2028 bid would read off Table 1 is the June recalculation unwinding. Alignment says it will litigate the 2027 measures, and Elevance sued over $115 million in July. A court has reopened the column bids price from in each of the last three years, and the 2026 one moved 22 contracts eight months after printing.
Further Reading
- Medicare Advantage's Quality Bonus Hits $13.4 Billion While the Qualified Base Shrinks to 68%
- 2027 Medicare Advantage Premiums Fall to $12 as Two in Ten Enrollees Lose Their Plan or Pay More
- CMS Star Ratings Recalculation After Clover: Asymmetric Design and 2027 MA Bid Methodology Risk
- CMS Star Ratings Overhaul Sends $18.6 Billion to MA Insurers Over the Next Decade
- UnitedHealth, Presbyterian and Humana's 2027 Medicare Advantage Exits Trace to County Benchmark Math
- Elevance Sues CMS Over $115M in Medicare Advantage Star Ratings: A Bonus Payment Consistency Problem
Sources
- 2027 Medicare Advantage and Part D Star Ratings Fact Sheet, Tables 1 to 9 and Appendix A1 (CMS, October 8, 2026)
- 2027 Medicare Advantage and Part D Star Ratings (CMS newsroom, October 8, 2026)
- 2026 Medicare Advantage and Part D Star Ratings Fact Sheet (CMS, October 2025)
- Announcement of CY 2027 Medicare Advantage Capitation Rates and Part C and Part D Payment Policies (CMS, April 6, 2026)
- 42 CFR 422.258, Calculation of benchmarks (Cornell LII)
- 42 CFR 422.266, Beneficiary rebates (Cornell LII)
- The Medicare Advantage Program: Status Report, Chapter 12, March 2026 Report to the Congress (MedPAC, March 2026)
- Humana Inc. Form 8-K on Final 2027 Star Ratings, Bonus Year 2028 (SEC EDGAR, October 9, 2026)
- Humana Soars, Alignment Plummets in 2027 Medicare Advantage Star Ratings (Healthcare Dive, October 9, 2026)
- Medicare Advantage Plan Availability Varies Widely by County for 2027 (KFF, October 9, 2026)