The methodology behind NCQA’s 2027 Health Plan Ratings is now final. The National Committee for Quality Assurance (NCQA) posted the last version on October 22, 2026, along with the measure list each plan is scored on, and the ratings themselves are due in September 2027. The headline rule is simple. A plan’s star rating is a weighted average of 1 to 5 scores on clinical and patient experience measures, and NCQA Accreditation adds 0.5 points before rounding. Because ratings round to the nearest half star, that bonus is worth exactly half a star to any accredited plan below the top of the scale.
The finer rules decide more ratings than the headline does. A measure a plan fails to report scores 0 and keeps its weight. Outcome measures count 3 times as much as screenings. 2 demographic measures pay full marks or nothing. The ratings cover commercial, Medicare Advantage and Medicaid plans, but not Exchange plans.
Key takeaways
- Accreditation is worth half a star. Accredited and Provisional plans get 0.5 bonus points before rounding, which moves the displayed rating up exactly one half-star step for any plan below 5. Interim status adds 0.15, which helps only near a rounding threshold.
- Unreported measures count against the plan. Not Reported, Not Required and Biased Rate results score 0 with full weight. Small denominators and benefits the plan does not offer drop out of the math.
- Outcomes carry triple weight. Blood pressure control, glycemic status and childhood and adolescent immunizations weigh 3, against 1 for process measures and 1.5 for patient experience.
- Demographic data is pass or fail. Plans earn a 5 on the race and ethnicity and language measures only if at least 25% of members have directly reported data, up from 20%. Otherwise they score 0.
- The 2027 list is shorter. NCQA removed 6 measures in March 2026, among them 2 patient experience measures and chlamydia screening. Medicare plans are not scored on the substance use follow-up measure dropped from their list.
How a plan’s rating is built
Every measure starts as a rate, either a clinical measure from the Healthcare Effectiveness Data and Information Set (HEDIS) or a patient experience score from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. NCQA truncates each rate to 3 decimals and compares it with national benchmarks drawn from all lines of business, at the 10th, 33.33rd, 66.67th and 90th percentiles. A rate in the top decile scores 5, the rest of the top third 4, the middle third 3, the bottom third outside the bottom decile 2, and the bottom decile 1. Rates where lower is better are inverted first, so that a higher number always means better performance.
Measure scores roll up into subcomposites, such as Cancer or Behavioral Health, then into 3 composites: Patient Experience, Prevention and Population, and Chronic Condition Management. Each level uses the same weighted average:
A composite or subcomposite rating, and the overall rating built the same way across all measures.Source: NCQA 2027 Health Plan Ratings Methodology
- the score on measure , a whole number from 0 to 5
- the measure’s weight, 1, 1.5 or 3
- the rating, before any accreditation bonus
The sums run over measures with a scorable result. A valid rate is scorable, and so are the 3 audit results that score 0, Not Reported (NR), Not Required (NQ) and Biased Rate (BR). Measures marked Small Denominator (NA) or No Benefit (NB) are left out of both sums. That distinction does most of the work in the rules for missing data. A plan that cannot report a measure because too few members qualify loses nothing, while a plan that chooses not to report it takes a 0 at full weight.
Some rules sit outside the average. A plan needs scorable results for at least 50% of all measures by weight, and a numerical rating on at least one subcomposite in each of the 3 composites, to receive an overall rating. Without them it is listed with “Partial Data Reported” or another status, and no stars. NCQA may also drop any measure from the ratings if fewer than 40% of submitted rates are valid.
The bonus and the rounding
The overall rating is truncated to 3 decimals, the accreditation bonus is added, and the result is rounded to the nearest half point:
The displayed star rating.Source: NCQA 2027 Health Plan Ratings Methodology, Table 1 and rounding rules
- rounding to the nearest half point, with 4.750 and above shown as 5
- the accreditation bonus, 0.5 for Accredited or Provisional status, 0.15 for Interim and 0 otherwise
The rounding bands are 0.5 wide and break at .250 and .750. Adding 0.5 therefore lifts every rating by exactly one band. A plan at 3.6 shows 3.5 stars without accreditation and 4 with it, and a plan at 4.3 goes from 4.5 to 5. The only plans the bonus cannot help are those already at 5.
The Interim bonus behaves differently. At 0.15, it changes the displayed rating only when the unrounded score sits within 0.15 of the next threshold, about 30% of each band. A plan at 3.62 moves from 3.5 to 4 stars with it, and a plan at 3.55 does not move at all.
Status is fixed on the last business day of June of the release year. A plan that becomes accredited in July carries no bonus into that September’s ratings. Status modifiers such as Under Corrective Action are appended to the status as of the same date.
The accreditation bonus is the one input that moves every eligible plan by the same half star. Everything else in the rating depends on where a plan’s scores fall against everyone else’s.
Where the weight sits
The measure list is different for each product line, and so is the balance between composites. Our tally of the October 2026 list:
| Commercial | Medicare | Medicaid | |
|---|---|---|---|
| Scored indicators | 43 | 40 | 43 |
| Total weight | 54.5 | 48 | 55 |
| Patient Experience weight | 4.5 | 6 | 6 |
| Prevention and Population weight | 35 | 25 | 34 |
| Chronic Condition Management weight | 15 | 17 | 15 |
| Weight on outcome measures weighted 3 | 15 | 9 | 15 |
Tallied from the 2027 Health Plan Ratings required measures list, October 22, 2026. Each weighted row counts as 1 indicator.
Commercial and Medicaid plans have 5 measures at weight 3: childhood immunizations, adolescent immunizations, controlling high blood pressure, blood pressure control for patients with diabetes, and glycemic status below 8%. Together they are more than a quarter of the total weight. Medicare plans have no childhood measures, so only the 3 cardiometabolic outcomes carry triple weight, and the Medicare list leans more on hospital-related care, including 4 transitions of care indicators.
Patient experience is a small share everywhere. Each CAHPS item weighs 1.5, but commercial plans have only 3 of them, 8% of their total weight. Medicare and Medicaid plans have 4, which come to 12.5% and about 11%.
The weights make reporting decisions concrete. Say a commercial plan would have scored 3 on controlling high blood pressure but reports NR. With all its measures scorable, its average falls by 9 divided by 54.5, or 0.165 points, a third of a rounding band from 1 measure.
Utilization and demographic measures are scored differently
Hospital use measures, such as plan all-cause readmissions and emergency department use, are reported as observed-to-expected (O/E) ratios that adjust for a plan’s case mix. NCQA divides the plan’s ratio and its 95% confidence limits by the national average O/E, then checks whether the plan is both meaningfully and significantly different from average.
| Result | Score |
|---|---|
| Calibrated O/E below 0.9 and upper confidence limit below 1.0 | 5 |
| Not meaningfully and significantly different from average | 3 |
| Calibrated O/E above 1.1 and lower confidence limit above 1.0 | 1 |
| NR, BR or NQ audit result | 0 |
| Fewer than 150 denominator events | NA |
From Table 2 of the 2027 methodology.
These measures have no 2 or 4. A plan with fewer admissions than expected scores 3 unless the gap is more than 10% and statistically clear, and the same buffer protects plans with more admissions than expected. Commercial plans have 3 of these measures, Medicare plans 4 and Medicaid plans 1.
The Race/Ethnicity Description of Membership (RDM) and Language Description of Membership (LDM) measures are pass or fail. A plan scores 5 on RDM if directly reported race and ethnicity data reach at least 25%, and 5 on LDM if known preferred written and spoken language data reach 25%. Below that, the score is 0. NCQA raised the threshold from 20% in March 2026. Each measure weighs 1, so the gap between passing both and failing both is 10 weighted points, about 0.18 on a commercial plan’s average.
What changed for 2027
The March 2026 posting removed 6 measures from the list.
| Measure | Removed from |
|---|---|
| Coordination of Care (CAHPS) | Commercial, Medicare |
| Getting Care Quickly (CAHPS) | Commercial |
| Asthma Medication Ratio | Commercial, Medicaid |
| Chlamydia Screening | Commercial, Medicaid |
| Fall Risk Management | Medicare |
| Weight Assessment and Counseling for Children and Adolescents, BMI percentile | Commercial, Medicaid |
From the summary of changes in the 2027 required measures list.
The same posting moved the 2 statin therapy measures to their electronic clinical data systems (ECDS) versions, removed references to the Health Outcomes Survey from the methodology and raised the RDM and LDM threshold. The October 2026 posting regrouped the patient experience measures into 2 subcomposites, Getting Care and Satisfaction With Plan and Plan Services.
The Medicare list also no longer includes the 7-day follow-up after high-intensity care for substance use disorder, which commercial and Medicaid plans still report. NCQA removed it from the Medicare measure list in Health Plan Accreditation in its March 2026 policy updates.
Timing differs by product line too. Commercial and Medicaid ratings use measurement year 2026 for both HEDIS and CAHPS. Medicare ratings use 2026 HEDIS but 2025 CAHPS, because Medicare’s survey runs on a different schedule, and using Medicare CAHPS at all depends on approval from the Centers for Medicare & Medicaid Services each year.
Timeline
From the final methodology to the 2027 ratings
5 dates · March 2026 to September 15, 2027
March posting
6 measures removed and the RDM and LDM threshold raised to 25%.
- Today
HEDIS and CAHPS submission Deadline
Accreditation status for the bonus is fixed on the last business day of June.
Projected ratings Review
Plans review their scoresheets privately.
Public release Release
Ratings appear on NCQA’s Health Plan Report Card.
Dates come from NCQA's 2027 Health Plan Ratings page and methodology.
What the method rewards
Read as incentives, the rules reward 3 things. Accreditation is the largest single lever, worth a full rounding band. Complete reporting comes next, because every NR is a 0 at full weight. Then come the triple-weighted outcomes, where a move from the middle third to the top third of plans on blood pressure control adds as much as the same move on 3 screening measures.
The ratings also rank plans against each other rather than against fixed targets. Measure scores come from national percentiles, so a plan can improve its rate and keep the same score if other plans improve as fast. The fixed points in the system are the accreditation bonus, the 25% demographic thresholds and the O/E bands. Everything else is relative.
About this analysis
Basis. The rules come from NCQA’s 2027 Health Plan Ratings Methodology and its list of required HEDIS and CAHPS measures, both posted October 22, 2026 and linked from NCQA’s 2027 Health Plan Ratings page, which also supplies the 2027 schedule.
Calculations. Indicator counts and weights are our tally of the required measures list, counting each weighted row once. The examples of 3.6, 4.3, 3.62 and 3.55 are illustrative scores, not plan results. The effect of 1 unreported measure assumes every other measure is scorable. The share of each band that the Interim bonus affects follows from the 0.5-wide rounding bands.
Frequently asked questions
How does NCQA calculate a health plan’s star rating for 2027?
NCQA scores each HEDIS and CAHPS measure from 1 to 5 against national percentiles, takes a weighted average, adds 0.5 points for Accredited or Provisional status or 0.15 for Interim, and rounds to the nearest half star.
How much is NCQA Accreditation worth in Health Plan Ratings?
The 0.5-point bonus moves an accredited plan’s displayed rating up exactly one half-star step, unless the plan is already at 5 stars.
What happens if a plan does not report a measure?
A Not Reported, Not Required or Biased Rate result scores 0 and keeps its full weight. Small denominators and benefits the plan does not offer are left out of the calculation.
When will the 2027 Health Plan Ratings be released?
NCQA’s 2027 ratings page lists September 15, 2027 for the public release.