CMS Recalculates 2026 Star Ratings, Lifting Clover Health to 4.5 Stars From 3.5

1 articles · Updated · MedCity News · Jun 28

Clover Health’s 2026 Medicare Advantage rating rose to 4.5 stars after CMS voluntarily recalculated some plans’ scores following a federal court loss.
The judge found CMS improperly used 20 quality measures— including medication adherence and call-center data—because the agency relied on unauthorized data sources and skipped required rulemaking.
CMS said it will update ratings only when recalculation produces a higher score, limiting the benefit to a small set of plans, especially those near key thresholds such as 4 stars.
For Clover, the change could preserve roughly $120 million in bonus payments tied to higher Star Ratings, though experts said CMS could still appeal and the broader fallout remains unclear.
The ruling adds pressure on CMS as it keeps reshaping the ratings program for 2027 by dropping several administrative measures, making methodology and measure selection even more consequential.