CareFirst BlueCross BlueShield has secured a two-week pause in its 2026 Medicare Advantage star ratings lawsuit, pointing to a ruling against the government last month that found widespread flaws in how the ratings are calculated.
On May 27, a federal judge in Georgia ruled in favor of Clover Health in its challenge to its 2026 MA star ratings, throwing out 20 measures CMS used in the calculation. The court found the agency overstepped its legal authority on 10 of those measures and skipped required public rulemaking procedures before adding the other 10. The decision may have implications for star ratings across the entire MA program, as the judge’s reasoning focused on broad problems with CMS’s methodology rather than anything specific to Clover.
On June 8, CareFirst asked the U.S. District Court in Washington, D.C. to pause its case for two weeks to give CMS time to weigh the Clover ruling and decide whether to act across the industry.
CareFirst has been fighting its own 2026 star rating for a contract covering roughly 30,000 Medicare beneficiaries in Maryland. The insurer claims a CMS miscalculation dropped its rating to 3.5 stars instead of 4, costing it more than $32 million in quality bonus payments for 2027.
In 2024, after courts sided against the government in star ratings lawsuits brought by SCAN Group and Elevance Health, CMS recalculated ratings for all MA plans.
“If CMS follows the same course as it did two years ago, it would likely moot the need for this court to grant the relief sought by CareFirst,” the insurer wrote.
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