Based on CMS's October 8 ratings release, the 2027 technical notes and measure weights, and Medicare's coverage and plan-comparison guidance.
Daily function has returned to Medicare's plan report card. CMS released its 2027 Medicare Advantage and Part D star ratings on October 8, bringing a revised functional-status assessment measure back into the ratings for Special Needs Plans. For OT readers, the release offers a reason to look beneath a plan's overall score before open enrollment begins October 15.
In brief
- The returning measure counts eligible Special Needs Plan members age 66 and older who received a functional assessment; it does not measure their improvement.
- Physical and mental health outcome measures each rise from a weight of one to three in the 2027 ratings.
- A plan's quality score leaves patient-specific questions about the OT network, costs, and prior authorization to be checked separately.
Read the assessment measure with its boundaries
CMS's technical notes define the functional-assessment measure as the share of Medicare Advantage Special Needs Plan enrollees age 66 and older who had at least one assessment during the measurement year. The 2027 rating uses January through December 2025 data. Exclusions apply, including hospice use and death during that year.
The measure asks whether an assessment occurred. It cannot tell a reader whether someone regained the ability to dress independently or prepare a meal. CMS assigns it a process-measure weight of one. The distinction matters when a clinic explains a score to a patient or discusses quality work with a payer.
For an OT practice working with a Special Needs Plan, this is a useful topic for the next quality meeting. Ask which assessment records the plan accepts, who receives them, and how missing information is reconciled. Confirm the plan's specifications before assuming an existing OT evaluation satisfies its reporting requirements.
Health outcomes carry more weight
The measures for improving or maintaining physical health and mental health each move from a weight of one in 2026 to three in 2027, following earlier changes to their specifications. CMS's measure list also includes reducing fall risk and improving bladder control, both with a weight of one.
Those subjects will be familiar to rehabilitation teams. Their presence in a plan score creates a starting point for discussion about daily function, follow-up, and care coordination. The ratings do not isolate the contribution of an individual therapist, and the new weights establish no new OT payment rate or automatic referral.
Keep that conversation specific. A practice might bring an example of how it communicates a change in a patient's support needs to the care team, then ask where that information belongs in the plan's workflow. A general promise to improve the star rating would go well beyond what this release demonstrates.
Check the coverage behind the score
Medicare's comparison guidance says Advantage plans must cover medically necessary services covered by Original Medicare. Networks, referrals, prior authorization, and out-of-pocket costs can differ. A high overall rating therefore leaves several practical questions unanswered for someone already receiving occupational therapy.
Start with the exact 2027 plan and the treating clinic. Confirm network participation with the plan and provider, ask about the cost of each outpatient OT visit, and check whether an active course of care requires authorization under the new coverage. Keep written answers with the plan documents so the family can return to them when scheduling.
Medicare's OT coverage page describes care that can improve or maintain current abilities or slow decline. Patients seeking maintenance care should include that purpose in their coverage questions. A conversation framed only around rapid improvement can miss the reason the person needs therapy.
Use the enrollment window to settle the details
The new ratings appear in Medicare Plan Finder for open enrollment, October 15 through December 7, 2026. CMS reports ratings at the contract level; a contract can encompass multiple plan benefit packages. Match the quality information to the actual plan being considered, then read its coverage documents.
An OT clinic can help patients identify the questions their treatment raises without choosing coverage for them. Someone continuing hand therapy may need a different conversation from someone arranging help with bathing after a hospital stay. Bring those needs to the comparison while there is time to obtain answers. The useful choice is the one whose coverage details the patient understands before the next appointment.