Clover Health Announces 53% Growth in Medicare Advantage Membership During AEP, Increasing to 153,000 Members as of January 1, 2026; Expects First-Ever Full Year GAAP Net Income Profitability in 2026

Rhea-AI Summary

Clover Health (Nasdaq: CLOV) reported a 53% year-over-year increase in Medicare Advantage PPO membership for the 2026 plan year, entering 2026 with ~153,000 members. The company said >95% AEP retention and that >97% of members are in its flagship PPO, which it ranks #1 nationally on core HEDIS metrics. Clover expects to achieve its first full-year GAAP net income profitability in 2026, citing improving cohort economics, SG&A leverage, a 4.0 Star payment impact, and a favorable 2026 CMS rate update.

Positive

• Membership +53% YoY to ~153,000 members
• >95% Annual Enrollment Period member retention
• >97% of members in flagship PPO ranked #1 on core HEDIS
• Company expects first full-year GAAP net income profitability in 2026

Negative

• Growth is concentrated in core markets, indicating geographic concentration
• Projected profitability partly depends on a 4.0 Star payment impact and CMS rate update

News Market Reaction

+10.63% 1.5x vol

23 alerts

+10.63% News Effect

+8.7% Peak in 2 hr 40 min

+$143M Valuation Impact

$1.49B Market Cap

1.5x Rel. Volume

On the day this news was published, CLOV gained 10.63%, reflecting a significant positive market reaction. Argus tracked a peak move of +8.7% during that session. Our momentum scanner triggered 23 alerts that day, indicating elevated trading interest and price volatility. This price movement added approximately $143M to the company's valuation, bringing the market cap to $1.49B at that time. Trading volume was above average at 1.5x the daily average, suggesting increased trading activity.

Data tracked by StockTitan Argus on the day of publication.

Key Figures

MA membership growth: 53% MA membership: 153,000 members Flagship PPO penetration: ~97% +5 more

8 metrics

MA membership growth 53% Year-over-year increase in Medicare Advantage PPO plans for 2026 plan year

MA membership 153,000 members Total Clover Medicare Advantage members as of January 1, 2026

Flagship PPO penetration ~97% Share of Jan 1, 2026 MA membership in flagship PPO plan

Member retention >95% AEP member retention for 2026 plan year

HEDIS Stars rating 4.0 Stars Payment year 2026 for Clover’s PPO plans

HEDIS #1 ranking duration 2 years Flagship PPO ranked #1 nationally on core HEDIS metrics

Plan size threshold 2,000 lives Non-SNP PPO plans included in HEDIS analysis

Measurement year MY 2024 CMS Star ratings basis for HEDIS analysis

Market Reality Check

Price: $2.04 Vol: Volume 4,666,560 is sligh...

normal vol

$2.04 Last Close

Volume Volume 4,666,560 is slightly above the 20-day average of 4,419,471, indicating typical trading activity into this announcement. normal

Technical Shares at $2.54 are trading below the 200-day MA of $2.95 and sit well under the $4.87 52-week high, though above the $2.12 52-week low.

Peers on Argus

CLOV was down 3.79% while key peers also traded lower: PGNY −12.09%, OSCR −2.88%...

CLOV was down 3.79% while key peers also traded lower: PGNY −12.09%, OSCR −2.88%, ALHC −1.41%, NEUE −0.69%, MOH −0.68%. Despite this broad weakness, momentum scanners did not flag a coordinated sector move, suggesting the setup was more stock-specific than a synchronized sector trade.

Historical Context

5 past events · Latest: Jan 12 (Positive)

Pattern 5 events

Date	Event	Sentiment	Move	Catalyst
Jan 12	AI clinical impact update	Positive	+1.5%	Showcased CA-driven clinical gains and #1 PPO HEDIS ranking.
Dec 16	Conference participation	Neutral	+0.8%	Announced CEO presentation at J.P. Morgan 2026 Healthcare Conference.
Nov 17	Conference participation	Neutral	+0.0%	Disclosed CFO appearance at 2025 Citi Global Healthcare Conference.
Nov 04	Q3 2025 earnings	Positive	-4.3%	Reported strong revenue, MA growth, raised 2025 guidance despite GAAP loss.
Oct 31	Board change	Neutral	+4.3%	Chelsea Clinton stepped down from Board after eight years of service.

Pattern Detected

Recent news has often seen modest alignment with sentiment, but Q3 2025 earnings showed a negative price reaction despite generally positive operational metrics and raised guidance.

Recent Company History

Over the last few months, Clover has highlighted consistent Medicare Advantage expansion and improving economics. On Nov 4, 2025, Q3 results showed 109,226 MA members and $496.7M in revenue, alongside a $24.4M GAAP net loss but positive adjusted profits and raised 2025 guidance. Subsequent filings detailed insider tax-withholding and small 10b5-1 sales, while January 2026 updates showcased AI-driven clinical impact and #1 HEDIS rankings. Today’s AEP update and 2026 GAAP profitability expectation build directly on those growth and margin-improvement signals.

Market Pulse Summary

The stock surged +10.6% in the session following this news. A strong positive reaction aligns with C...

Analysis

The stock surged +10.6% in the session following this news. A strong positive reaction aligns with Clover’s emphasis on profitable growth, with MA membership reaching 153,000 and rising 53% year-over-year. The company also guided to its first full year of GAAP net income profitability in 2026 and highlighted >b>95% retention and ~97% flagship PPO penetration. Investors comparing this to prior news may weigh execution on cohort economics and whether growth, margins, and capital needs can all remain balanced.

Key Terms

gaap, medicare advantage, ppo, hedis, +2 more

6 terms

gaap financial

"first-ever full year GAAP Net Income profitability in 2026"

GAAP, or Generally Accepted Accounting Principles, are a set of standardized rules and guidelines that companies follow when preparing their financial statements. They ensure consistency, transparency, and comparability across different companies, making it easier for investors to understand and compare financial information accurately. This helps investors make informed decisions based on trustworthy and uniform financial reports.

medicare advantage medical

"53% year-over-year membership growth in its Medicare Advantage (MA) PPO plans"

Medicare Advantage is a type of health insurance plan offered by private companies that covers services traditionally provided by government-run Medicare. Think of it as a bundled package that combines hospital, doctor, and other medical care into one plan, often with added benefits. For investors, it matters because the popularity and profitability of these plans can influence healthcare companies and the broader health insurance industry.

ppo technical

"membership growth in its Medicare Advantage (MA) PPO plans for the 2026 plan year"

A PPO, or preferred provider organization, is a type of health insurance plan that gives members a network of doctors and hospitals who agree to lower fees, while still allowing patients to see providers outside the network at higher cost. Investors care because PPOs influence how medical services are paid for and used, affecting revenue and margins for insurers, hospitals, drug makers and companies that serve employer health plans—think of it as a merchant discount program that shapes who customers choose and what they pay.

hedis medical

"ranked #1 nationally on core HEDIS metrics"

HEDIS is a standardized set of measures used to evaluate how well health insurance plans deliver care and preventive services. Think of it like a report card that compares plans on things such as screenings, chronic-disease management and vaccination rates; investors monitor HEDIS scores because they affect plan reputation, consumer choice, quality-linked payments and regulatory scrutiny, all of which can influence membership, revenue and long-term growth.

cms regulatory

"measures applicable to non-SNPs that were used for CMS’s MY 2024 Star ratings"

The Centers for Medicare & Medicaid Services (CMS) is the U.S. federal agency that sets rules, payment rates and coverage decisions for major public health insurance programs; think of it as both a giant insurer and the rulebook maker for how many healthcare providers and drug makers get paid by government programs. Its policy changes and reimbursement decisions can materially affect revenue, profit forecasts and valuations for hospitals, insurers, device makers and drug companies, so investors watch CMS announcements closely.

non-snp medical

"performance by non-SNP PPO plans with over 2,000 lives"

Non-SNP denotes genetic variation that is not a single-letter change in DNA; it covers larger or different types of differences such as insertions, deletions, repeats or structural rearrangements. For investors, these variants matter because they can affect disease tests, drug targets, regulatory approval and intellectual property — like spotting a missing paragraph instead of a single typo, which can change clinical outcomes, product value and market potential.

AI-generated analysis. Not financial advice.

• Clover delivers market-leading Medicare Advantage growth, establishing a strong path to achieve its first-ever full year GAAP Net Income profitability in 2026.
• Disciplined, core-market growth, strong returning member retention, and improving cohort economics position Clover for compounding earnings and margin expansion.
• Powered by AI, Clover continues to bring industry-leading clinical quality to members, with ~97% of Clover’s January 1, 2026 membership in flagship PPO plan that is ranked #1 nationally on core HEDIS metrics.
  

WILMINGTON, Del., Jan. 14, 2026 (GLOBE NEWSWIRE) -- Clover Health Investments, Corp. (Nasdaq: CLOV) (“Clover,” “Clover Health” or the “Company”), today announced 53% year-over-year membership growth in its Medicare Advantage (MA) PPO plans for the 2026 plan year. Following this strong Annual Enrollment Period (AEP), Clover enters 2026 with approximately 153,000 members, reflecting disciplined growth primarily in core markets, with strong retention, supporting Clover’s path toward expected full year 2026 GAAP Net Income profitability.

Key AEP and Business Highlights:

• Strategic Growth: Clover reports a 53% Medicare Advantage membership increase year-over-year, achieved amidst a broader industry retreat, which is concentrated in established core markets where the Company maintains strong Clover Assistant (CA) coverage and a differentiated Home Care offering to deliver better care and drive improving cohort performance.
• Expects Full Year 2026 GAAP Net Income Profitability: Clover expects to be positioned to achieve first-ever Full Year GAAP Net Income profitability driven by strong cohort economics and efficiencies from continued SG&A leverage and optimization.
• Strong Visibility into Cohort Economics Improvement: Clover anticipates meaningful new member cohort improvement and continued strong returning cohort performance, complementing sustained growth and supported by:
  • Financial impact of 4.0 Stars during payment year 2026 for Clover’s PPO plans,
  • Favorable 2026 CMS final rate update & increased Part D direct subsidy,
  • Strong returning member retention,
  • Focus on increasing Clover Assistant coverage & PCP adoption, and
  • Continued operating leverage as SG&A efficiency improves with scale.
• Stable Benefits & Strong Member Retention: Clover strategically maintained stable plan benefits year-over-year, delivering >95% AEP member retention. This reinforces the stability of the Company’s membership base and the enduring value of Clover plan offerings to attract and retain members. This led to intentional PPO growth, with the vast majority of Clover's new membership being MA switchers located within core markets, as expected.
• Industry-Leading Quality: >97% of Clover’s January 1, 2026 MA membership is in its flagship PPO plan, which is ranked as the #1 PPO plan nationally on core HEDIS quality measures for the second year in a row¹, reinforcing the strength of Clover’s clinical and economic performance.
  
  

"This year’s AEP performance shows what happens when robust plan benefits, Clover Assistant-enabled clinical performance, and a deepening market presence in local communities come together,” said Jamie Reynoso, CEO of Medicare Advantage at Clover Health. “We have replicated our AEP growth playbook from last year, and are proud to have exceeded our expectations in delivering market-leading growth this enrollment period. This is a direct result of targeted, sustainable, and concentrated growth in our core markets where we continue to scale Clover Assistant and Home Care to meet members where they are.”

"We are entering 2026 on a strong financial trajectory," said Andrew Toy, Chief Executive Officer of Clover Health. "We believe this year will demonstrate the full power of Clover’s model: significant member growth and strong returning member retention, layered onto meaningfully improving cohort performance and the continued impact of Clover Assistant. Together, we believe these dynamics will create compounding earnings and margin expansion over time, which we expect to position Clover to deliver its first year of GAAP Net Income profitability in 2026.”

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¹ This analysis focuses on performance by non-SNP PPO plans with over 2,000 lives as of September 1, 2025 on HEDIS measures applicable to non-SNPs that were used for CMS’s MY 2024 Star ratings, applying the measure ranges used by CMS.

Forward-Looking Statements:
This press release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. Forward-looking statements include statements regarding future events and Clover Health’s future results of operations, financial position, business strategy and future plans. Forward-looking statements are not guarantees of future performance, and you are cautioned not to place undue reliance on such statements. In some cases, you can identify forward looking statements because they contain words such as “may,” “will,” “should,” “expects,” “plans,” “anticipates,” “going to,” “can,” “could,” “should,” “would,” “intends,” “target,” “projects,” “contemplates,” “believes,” “estimates,” “predicts,” “potential,” “outlook,” “forecast,” “guidance,” “objective,” “plan,” “seek,” “grow,” “target,” “if,” “continue” or the negative of these words or other similar terms or expressions that concern Clover’s expectations, strategy, priorities, plans or intentions. Forward-looking statements in this press release include, but are not limited to, expected 2026 GAAP Net Income profitability and Clover’s anticipated financial results associated with CMS’ Stars rating of 4.0 for Clover’s PPO MA plans for payment year 2026, its 2026 financial outlook, future membership growth and retention, Clover assistant usage and investment, CMS’ 2026 rate update, Part D direct subsidies, and cost efficiency initiatives, as well as our expectations related to Clover’s GAAP Net Income, liquidity, future performance, future operations and future results. These statements are subject to known and unknown risks, uncertainties and other factors that may cause Clover Health’s actual results, levels of activity, performance or achievements to differ materially from results expressed or implied in this press release. Forward-looking statements involve a number of judgments, risks and uncertainties, including, without limitation, risks related to: our expectations regarding results of operations, financial condition, and cash flows; our expectations regarding the development and management of our business; any current, pending, or future legislation, regulations or policies that could have a negative effect on our revenue, profit margins, cash flows and business, including rules, regulations and policies relating to healthcare, Medicare generally and medical loss ratios; our ability to successfully enter new service markets and manage our operations; anticipated trends and challenges in our business and in the markets in which we operate; our ability to effectively manage our beneficiary base and provider network; our ability to maintain and increase adoption and use of Clover Assistant, including the expansion of Clover Assistant for external payors and providers under the brand name Counterpart Assistant; the anticipated benefits associated with the use of Clover Assistant, including our ability to utilize the platform to manage our medical expenses; our ability to maintain or improve our Star Ratings or otherwise continue to improve the financial performance of our business; our ability to develop new features and functionality that meet market needs and achieve market acceptance; our ability to retain and hire necessary employees and staff our operations appropriately; the timing and amount of certain investments in growth; the outcome of any known and unknown litigation and regulatory proceedings; our ability to maintain, protect, and enhance our intellectual property; general economic conditions and uncertainty; persistent high inflation and fluctuating interest rates; and geopolitical uncertainty and instability. Additional information concerning these and other risk factors is contained in Clover Health’s most recent Annual Report on Form 10-K, filed with the Securities and Exchange Commission (the “SEC”) on March 3, 2025, and in our subsequent filings with the SEC, in each case where relevant, including the Risk Factors sections therein, and in its other filings with the SEC. The forward-looking statements included in this press release are made as of the date hereof. Except as required by law, Clover Health undertakes no obligation to update any of these forward-looking statements after the date of this press release or to conform these statements to actual results or revised expectations.

About Clover Health:
Clover Health (Nasdaq: CLOV) is a physician enablement technology company committed to bringing access to great healthcare to everyone on Medicare. This includes a focus on seniors who have historically lacked access to affordable, high-quality healthcare. Our strategy is powered by our software platform, Clover Assistant, which is designed to aggregate patient data from across the healthcare ecosystem to support clinical decision-making and improve health outcomes through the early identification and management of chronic disease. For our members, we provide PPO and HMO Medicare Advantage plans in several states, with a differentiated focus on our flagship wide-network, high-choice PPO plans. For healthcare providers outside Clover Health's Medicare Advantage plan, we extend the benefits of our data-driven technology platform to a wider audience via our subsidiary, Counterpart Health, and aim to enable enhanced patient outcomes and reduced healthcare costs on a nationwide scale. Clover Health has published data demonstrating the technology’s impact on Medication Adherence, Congestive Heart Failure, Chronic Obstructive Pulmonary Disease, and in Underserved Populations as well as the earlier identification and management of Diabetes and Chronic Kidney Disease.

Investor Relations:
Ryan Schmidt
investors@cloverhealth.com

Press Inquiries:
press@cloverhealth.com

FAQ

How many Medicare Advantage members does CLOV have as of January 1, 2026?

Clover entered 2026 with approximately 153,000 members in Medicare Advantage PPO plans.

What membership growth did CLOV report for the 2026 plan year?

Clover reported a 53% year-over-year increase in Medicare Advantage PPO membership for the 2026 plan year.

What profitability guidance did CLOV give for 2026?

Clover expects to achieve its first full-year GAAP net income profitability in 2026, driven by cohort improvements and SG&A leverage.

What retention and plan-quality metrics did CLOV report for AEP 2026?

The company reported >95% AEP member retention and that >97% of members are in its flagship PPO ranked #1 on core HEDIS measures.

How does the 4.0 Star rating affect CLOV's 2026 results?

Clover cites the financial impact of a 4.0 Star rating during payment year 2026 as a factor supporting cohort economics and revenue.

Is CLOV's 2026 growth geographically broad or concentrated?

Clover said its growth was concentrated in established core markets where it has Clover Assistant coverage and Home Care offerings.