Healthfirst is the latest insurer to sue the federal government in a bid to overturn its 2027 Medicare Advantage star rating it says will cost the plan more than $380 million.
The New York City-based insurer, which has more than 300,000 MA enrollees, received a 3.5-star rating for 2027, down from 4.5 stars the prior year. Healthfirst alleges that if CMS had not calculated its rating using five measures that were never formally adopted through the rulemaking process, it would have received 4 stars.
The complaint, filed Oct. 19 in the U.S. District Court for the Southern District of New York, builds on a May ruling in favor of Clover Health that found CMS had used star rating measures that didn’t go through rulemaking. After that ruling, CMS removed 20 measures from Clover’s ratings but declined to extend the same relief to other plans.
Alignment Healthcare filed a similar challenge against its 2027 star ratings earlier this month, arguing it could lose more than $200 million in 2028 bonus payments. SCAN and Elevance Health also have pending suits challenging their 2026 ratings on similar grounds.
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