For Stars, quality, member-communications and compliance leaders at health plans
The letters behind your Stars, HEDIS and Medicaid renewals
With 11 measures leaving the Star Ratings, more of your rating rests on CAHPS, the Health Outcomes Survey and Part D adherence. CAHPS asks whether members got the information and help they needed, HOS asks how their health changed, and adherence counts what they did. HealthLiteracyCopilot ranks your member documents by the measures they touch, fixes the worst under your reviewers, and helps you measure the change on your own members.
Send a blank template, not a copy with a patient's or member's details.
HealthcareGPS is SOC 2 Type II audited and HIPAA compliant. How we protect your documents
37%
of Medicare Advantage drug-plan contracts earned 4 stars or more in the 2027 Star Ratings. Five-star contracts fell to 15, from 22 in CMS's revised 2026 ratings.
Source: CMS, 2027 Star Ratings fact sheet (October 2026)
At least $13.4 billion
in Medicare Advantage quality bonus payments in 2026. A plan earns the bonus at 4 stars or more.
Source: KFF, Medicare Advantage Quality Bonus Payments (2026)
Jan 1, 2027
Medicaid work requirements and 6-month renewals start for expansion adults, unless HHS gives a state more time for work requirements. States must reach enrolled adults before then.
Source: CMS, community engagement interim final rule fact sheet (2026-06-01)
What we fix
What a member letter needs to show
- What to do and by when, at the top.
- Plain words in short sentences.
- One number to call, and language help for members who need it.
Illustrative example.
One clear path, from enrollment to renewal
A member gets dozens of documents a year. Each one is a step on the same path. If one step is unclear, the next one gets harder. Here is where each document sits, and what it feeds.
Stage 1: Shop & Enroll
- Touchpoints
- Plan comparison guides, Summary of Benefits, Enrollment forms
- What we do
- Score and revise to your target grade; Spanish variants
- Measure it feeds
- Enrollment completion
Stage 2: Welcome & Activate
- Touchpoints
- Welcome kit, ID card letter, First texts and emails
- What we do
- Channel versions with SMS and email limit checks
- Measure it feeds
- Health-assessment completion, portal sign-up
Stage 3: Understand Benefits
- Touchpoints
- Evidence of Coverage, EOB, Annual Notice of Change
- What we do
- Plain-language revision with a meaning check and your glossary
- Measure it feeds
- CAHPS Customer Service, call-center contacts
Stage 4: Close Care Gaps
- Touchpoints
- Screening reminders, Gap-closure letters
- What we do
- Persona testing on simulated readers before send
- Measure it feeds
- HEDIS screening measures
Stage 5: Stay Adherent
- Touchpoints
- Refill reminders, Drug-list changes, Mail-order letters
- What we do
- "Numbers to verify" check on doses, dates and costs
- Measure it feeds
- Part D adherence (PDC) measures
Stage 6: Manage Condition
- Touchpoints
- Care-management letters, Action plans, Teach-back handouts
- What we do
- Create action plans at target grade; journeys with persona variants
- Measure it feeds
- HEDIS chronic-care measures, care-plan follow-through
Stage 7: Renew & Retain
- Touchpoints
- Renewal notices, Denial and appeal letters, ANOC
- What we do
- Mandate checks (CMS MCMG, 42 CFR 438.10) where measurable
- Measure it feeds
- Disenrollment, Medicaid renewal completion, CAHPS Rating of Health Plan
Measures these touchpoints feed. Clear letters are one part of each measure. A study against your own starting point shows how much they add.
Where member documents count in the 2027 Star Ratings
- Star Ratings: Part D adherence and the two Health Outcomes Survey (HOS) outcome measures count 3x in the 2027 Star Ratings; CAHPS patient-experience measures count 2x.
- HEDIS: screening and chronic-care gaps close only when a member acts. Measurement year 2026 closes on December 31.
- CAHPS: Rating of Health Plan, Getting Needed Care, Care Coordination and Customer Service.
Clear letters are one lever you control. Your own data decides what they add.
Source: CMS, 2027 Star Ratings measures (2026); NCQA, HEDIS Measurement Year 2026.
Prove it on your own members
Split your next gap-letter or refill mailing. Half your members get today's letter, half get the revised one your reviewers approved. Same envelope, timing and channels.
Before it starts, you pick the measure (gaps closed within 90 days, refills within 30 days, or calls about the notice) and write the rule that decides, such as "expand if the revised group does better and the 95% interval excludes zero." No lift is promised. Your data decides, not ours.
We work from templates only. Your members' data stays with you.
Why refill letters matter
About 50% of patients with long-term conditions don't take their medicines as prescribed. A clear refill letter is one way to help. It tells people what to do, and when.
About 50%
of patients with long-term conditions don’t take medicines as prescribed
One drug-cost change, made clear
Here is one passage from an Annual Notice of Change. We show the grade, the fixes and what a reviewer still confirms.
Illustrative ANOC passage. Not a customer document. Grades measured with the HealthLiteracyCopilot readability engine (Flesch-Kincaid).
Effective January 1, 2027, your plan's Tier 3 non-preferred brand copayment1 will increase from $47 to $60 per 30-day supply at a network retail pharmacy, subject to applicable deductible requirements2, as described in your Evidence of Coverage.
Starting January 1, 2027, some brand-name drugs will cost more. These are called Tier 3 drugs.1 For a 30-day supply at a network drug store, you will pay $60. Today you pay $47.3 You may need to pay your deductible first.2 To see if your drug is Tier 3, call Member Services.4
What changed and why
- 1Glossary: your plan's term "Tier 3" is kept and explained in plain words.
- 2Meaning check: the deductible condition is kept, not dropped.
- 3Numbers to verify: $47, $60, "30-day" and the date are flagged for a reviewer to confirm.
- 4Actionability (PEMAT): adds the one thing the member can do next.
- Meaning check
- Same cost change, same deductible condition: passed
- Numbers to verify
- $47, $60, 30-day and the date: flagged for a reviewer
- Approval
- Reviewer approves the added next step
Dates that set the calendar
- By Sep 30 each year
- Annual Notice of Change must reach Medicare members.
- Early October
- Star Ratings release. The 2027 ratings came out on Oct 8, 2026: 37% of Medicare Advantage drug-plan contracts reached 4 stars or more, and five-star contracts fell to 15, from 22 in CMS's revised 2026 ratings.
- Oct 15 – Dec 7
- Medicare Annual Enrollment Period.
- Jan 1 – Dec 31
- Measurement year: the letters you send now count toward ratings two years out. Measurement year 2026 closes on December 31.
- Since 2026-01-01
- Prior-authorization decisions on items and services other than drugs: 7 calendar days for standard and 72 hours for expedited requests, with a specific reason for a denial in the response to the provider (CMS-0057-F). Medicare Advantage plans since January 1, 2026; Medicaid managed care plans from the first rating period that starts on or after that date.
- 2027-01-01
- Medicaid work requirements and 6-month renewals begin, unless HHS gives a state more time for work requirements; states must reach enrolled adults before then. The CMS-0057-F prior-authorization API is due the same day.
- 2027-05-11
- HHS §504 accessibility deadline for recipients with 15+ employees.
ADA Title II and HHS §504 dates verified 2026-10-08 against the Federal Register: DOJ interim final rule, 91 FR 20902 (2026-04-20); HHS interim final rule, FR doc 2026-09266 (2026-05-11), 45 CFR 84.84(b). Both keep WCAG 2.1 AA.
How accessibility review worksDenial letters members can act on
Since January 1, 2026, CMS-0057-F has required Medicare Advantage plans to give the provider a specific reason for a prior-authorization denial. The member's own notice already had to state the specific reasons. In 2024, Medicare Advantage plans denied 4.1 million requests for prior approval. Only about 1 in 9 denials was appealed. Four in five appeals won.
A letter that says why, and what to do next, gives members a fair chance to respond. We check each denial template for a clear reason, the criteria used and the appeal steps. State rules are checked too, such as Iowa's rule to name the criteria.
Source: CMS, Interoperability and Prior Authorization final rule (CMS-0057-F); KFF analysis of 2024 Medicare Advantage prior authorization data (52.8 million requests; 7.7% denied; 11.5% of denials appealed; 80.7% of appeals overturned).
Get a free assessment of one denial letterAI drafts, with a record of review
Plan AI assistants now reach millions of members. Teams draft letters with AI, too. State insurer AI laws ask for oversight. Some require you to tell members when AI is used.
HealthLiteracyCopilot scores AI drafts and chat replies against your rules. The scorer never grades its own revisions. A named reviewer signs off, and each sign-off keeps the score, the rubric version and the time.
Why HealthLiteracyCopilot
Instead of your team and an agency
"Reviewers argue about wording, and every cycle is opinion."
Standards, not opinion: IHA's N-PLAT, AHRQ's PEMAT and reading grade on every version, with a reason for each change.
See the standards we score withInstead of ChatGPT or Copilot
"AI might change a dose, a date or a disclaimer."
Built for regulated text: a clinical anchor gate, protected terms, and a scorer that never grades its own revisions.
How we differ from general AIInstead of a translation vendor
"Spanish and Section 1557 are where we get caught."
Spanish measured as Spanish, translation risk set by language, and a human translator for any segment that could lose a dose, a number or a "do not".
How we measure SpanishInstead of a readability checker
"Where do we start with 2,000 templates?"
Portfolio Scan ranks the whole library worst first, by the measure each document touches.
See how a library scan worksInstead of focus groups
"Will people actually understand it?"
Test before you send: simulated readers built from your personas, and a teach-back simulator for staff.
See persona testingInstead of shared drives and email
"We have to prove it to NCQA, The Joint Commission or MLR."
The record reviewers ask for: the criteria, the version, the reviewer and the date for every document.
See the review record
In their words
What people using it say
…sent exactly what you sent us to our privacy legal team for review and approval and they had no notes. … the tool knocked it out of the park on the first try.
Director of communications, regional health plan I'm impressed with this tool and I think it'll help us a lot to improve our outreach with our members.
Director of customer experience, Medicare Advantage plan
From people using HealthLiteracyCopilot, shared anonymously by role and type of organization. Trimmed where marked (…), never reworded.
Built for each role on your team
What each person is measured on, the documents they own and the parts of the platform they'd use most.
- Member communicationsFewer review rounds. Every change explainedFor directors of member communications at health plansOn-time AEP mailingsReview cycles per documentMember complaints Read more
- Stars and quality leadersFind the letters behind your CAHPS scores, before the survey doesFor VP Stars, chief quality officers and VPs of qualityStar ratingCAHPSHEDIS gapsQuality bonus payments Read more
- Compliance and language accessShow the reviewer which criteria, which version, who approvedFor compliance officers and language-access leadsAudit findings§1557 and §438.10 conformanceComplaints to Medicare (CTMs) Read more
- Utilization managementA specific denial reason is required now. Make it one the member can followFor VPs of utilization management, prior authorization and appeals at health plansCMS-0057-F complianceAppeal volumeOverturn rate Read more
Start with the letters that count this year
The Stars Shift Brief shows where member documents still count after the latest changes. The HEDIS Gap-Closure Letter Kit gives you letters you can test this month. Or send us one real notice. It comes back in Word with the changes to make and the reason for each one.
Send a blank template, not a copy with a patient's or member's details.
HealthcareGPS is SOC 2 Type II audited and HIPAA compliant. How we protect your documents
Questions
Can better member letters improve CAHPS scores?
CAHPS asks members whether they got needed care, understood their plan and found forms easy. Letters shape each of those experiences. HealthLiteracyCopilot doesn't promise a score change. It finds the notices most likely to cause confusion. Then you can split a mailing and let your own data show what changed.
Do you need member PHI?
No. A review uses your template library: blank or sample notices. No member data is needed.
Will this help us pass NCQA or URAC?
We don't award accreditation or promise a survey result. We produce material-level evidence (criteria, versions and reviewer approvals) that your accreditation team can include in its file.
How is this different from a readability checker?
Readability formulas measure sentence and word length. We also score actionability (PEMAT) and IHA health-literacy criteria, measure Spanish with Spanish instruments, and keep a reviewer-approved record.
Who reviews AI-revised notices before they go out?
Your team. Every revision shows its rationale and needs a reviewer's approval. HealthLiteracyCopilot doesn't send communications.
Will clearer letters raise our Star Rating?
We don't promise a Star or a score change. Letters are one lever among many, and no published study has measured this for a plan's rating. That is why we suggest a split mailing on your own members, judged by a rule you set before it starts.