Retaining Diabetic Eye Exams in Medicare Advantage Star Ratings: A Policy Commentary on Prevention, Equity, and...

In 2025, the Centers for Medicare and Medicaid Services (CMS) proposed removing the diabetic eye examination measure from the Medicare Advantage Star Ratings program, raising concern about the future visibility of preventive vision care within chronic disease management. Following public comment and stakeholder engagement, CMS retained the measure in the 2026 final rule. This editorial examines the policy implications of that decision for quality measurement, prevention, health equity, and value-based care. Diabetic retinopathy remains a major and growing cause of preventable vision loss in the United States, with important implications for Medicare beneficiaries, underserved populations, and health system costs. Although the diabetic eye examination measure presents challenges related to attribution, care coordination, and follow-up, these challenges reflect systemic barriers that require stronger implementation strategies rather than removal from accountability frameworks. Retaining the measure signals the continued importance of prevention in diabetes care and creates an opportunity to modernize quality measurement through integrated, equitable, and technology-enabled models that address screening disparities, referral completion, comprehensive diabetic eye care, and closed-loop follow-up.