Clover Health Investments CorpClover Health won lawsuit forcing CMS to recalculate star ratings, potentially restoring $120M in bonus payments.
The Centers for Medicare and Medicaid Services is recalculating 2026 Medicare Advantage star ratings for insurers after losing a court case over its methodology, but only plans that see their scores increase will have ratings updated and be allowed to resubmit bids. The recalculation stems from a lawsuit by Clover Health, whose largest plan dropped from 4 stars to 3.5 stars, costing the company about $120 million in bonus payments. A Georgia federal judge ordered CMS to recalculate Clover's rating without 20 disputed measures, and the agency has now voluntarily extended the recalculation to other plans, though it is removing only measures the judge ruled CMS lacked authority to collect, along with some additional unchallenged measures. TD Cowen analysts estimate that if the Clover criteria were applied broadly, UnitedHealthcare's average scores would rise from 4.11 to 4.27, a $500 million benefit, and Elevance's would move from 3.9 to 3.92, a $25 million benefit, but the current approach yields little change for most insurers. CMS noted the recalculation does not affect its right to appeal the ruling, and the move could prompt further lawsuits from insurers unhappy with their ratings.
Clover Health Investments CorpClover Health won lawsuit forcing CMS to recalculate star ratings, potentially restoring $120M in bonus payments.
UnitedHealth Group IncorporatedUnitedHealthcare could gain $500M if broad criteria applied, but current recalculation limited; uncertainty remains.
Elevance Health IncElevance may see slight benefit ($25M) if criteria applied broadly, but current approach yields little change.