CMS elevated Clover Health’s Medicare Advantage star rating from 3.5 to 4.5 for its largest contract, according to a June 9 regulatory filing.
Clover’s PPO covers 97% of its members, and the litigation did not include Clover’s HMO contract, which will retain its 4-star rating. CMS also instructed Clover to submit alternate bids reflecting the revised PPO rating.
Star ratings affect funding boosts for Medicare Advantage. The 4.5- and 4-star ratings support Clover in the 2027 payment year. Generally, the threshold for securing bonus payments is 4 stars.
In late May, a federal judge in Georgia called for CMS to recalculate the rating, identifying the improper inclusion of 20 measures. In the lawsuit, which dates back to November, Clover alleged roughly $120 million in quality bonus and other payments was at stake.
“The fact that the ratings trigger statutorily mandated funding increases is more than mere ‘influence’ or an ‘indirect’ effect; it is a deciding principle in the payment amount,” the judge wrote in her opinion.
Across for-profit and nonprofit MA plans with prescription drug coverage, the 3.5-star rating was the most common for 2026, according to a November 2025 fact sheet.
Earlier this month, CareFirst BlueCross BlueShield secured a two-week pause in its own star ratings lawsuit. CareFirst requested the pause so CMS could consider the Clover ruling and its broader applicability.
Becker’s contacted CMS and will update this story if more information becomes available.
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