CVS · 10-Q · 2026Q3 · Full report
Medicare Advantage Payment Outlook
CVS HEALTH Corp · 2026-11-04 · Importance 33 · Surprise 32
On April 6, 2026, the U.S. Centers for Medicare & Medicaid Services issued final 2027 Medicare Advantage payment rates, which imply an average industry revenue increase of 2.48%, excluding CMS’s estimate of Medicare Advantage risk score trend. Under the ACA, plans need at least four stars to qualify for bonus payments, and the 2027 ratings determine eligibility for bonuses in 2028. Based on September 2026 membership, more than 69% of CVS Health’s Medicare Advantage members were in plans rated at least four stars, down from more than 81% based on September 2025 membership and 2026 ratings.
Key facts
- CMS's final 2027 Medicare Advantage payment rates, issued April 6, 2026, produced an expected average industry revenue increase of 2.48%, excluding CMS's estimate of Medicare Advantage risk-score trend. source
- Based on September 2026 membership, more than 69% of CVS Health Medicare Advantage members were in plans rated at least 4.0 stars for 2027, compared with more than 81% of members based on September 2025 membership for 2026 ratings. source
- CVS Health's 2027 Medicare Advantage star ratings will determine which plans qualify for bonus payments in 2028. source
- CVS Health is exposed to changes in government funding, regulation and policy for Medicare and Medicaid, including amounts payable, program reforms or surcharges, and risk-adjustment mechanisms. source
- Medicare Advantage plans need at least four stars out of five to qualify for bonus payments. source