Clover Health Medicare Advantage PPO Plans Earn 5 Star Rating for 2027

The 5-Star PPO rating enables year-round beneficiary enrollment and affects payment year 2028.

Rhea-AI Summary

Clover Health (Nasdaq: CLOV) earned a 5-Star rating for its Medicare Advantage PPO plans for 2027, affecting payment year 2028. The Centers for Medicare & Medicaid Services (CMS) also awarded its HMO plan 4.5 Stars. The 5-Star rating enables year-round beneficiary enrollment in the PPO plans.

CMS calculated the PPO rating excluding 20 measures covered by a May 27, 2026 court decision that is on appeal. Including those measures would have produced 4.5 Stars. Clover’s score on core HEDIS measures, which assess care quality, remained 4.82 out of 5 Stars under either methodology.

Through the first half of 2026, Medicare Advantage membership grew ~48% year-over-year to more than 157,000 members, with ~98% in PPO plans. Clover said the higher rating allows further reinvestment in more competitive benefits.

6 points · 1 major

PositiveiHow this balance works

How this balance works

Rhea-AI gives every point it takes from this document a weight. Minor counts 1, Moderate 3 and Major 9, so one Major point outweighs several Minor ones. The bar adds up the weights on each side, and when neither side holds more than 65% of the total the balance reads Mixed.

It reads the document as published, with the same rules for every company, and it does not look at what the market expected or at how the stock traded, so a point can be objectively good on a day the stock falls.

Rhea-AI Sentiment measures something else, the tone of the wording.

How the balance worksHow Sentiment works

0 major · 2 points

Hollow bars mark forward-looking points. How the balance works

Positive

• Major pointPPO plans earned 5 Stars for 2027, affecting payment year 2028.
• Moderate pointMedicare Advantage membership grew ~48% year-over-year to more than 157,000 through the first half of 2026.
• Minor pointThe 5-Star PPO rating enables year-round beneficiary enrollment.
• Minor pointThe HMO Medicare Advantage plan earned 4.5 Stars for 2027.
• Minor pointCore HEDIS care-quality measures scored 4.82 out of 5 Stars, unchanged under either CMS methodology.
• Minor point. Forward-looking: it has not happened yet and may not happen.Clover said the higher rating allows further reinvestment in more competitive benefits.

Negative

• Moderate pointThe court decision underlying exclusion of 20 PPO rating measures is on appeal.
• Minor pointIncluding the excluded measures would have yielded 4.5 Stars for PPO plans rather than 5 Stars.

News Explained

The rating also has a payment channel beyond enrollment: CMS says Star ratings affect Medicare Advantage plan payments, and Clover’s 5-Star PPO rating applies to payment year 2028.

Key Figures

PPO Medicare Advantage rating: 5 Stars HMO Medicare Advantage rating: 4.5 Stars Payment year: 2028 +4 more

PPO Medicare Advantage rating

5 Stars

2027 Star Ratings

HMO Medicare Advantage rating

4.5 Stars

2027 Star Ratings

Payment year

2028

Payment year affected by the 2027 Star Ratings

Measures excluded in CMS calculation

20 measures

PPO rating calculation under the court decision, which is on appeal

PPO rating with included measures

4.5 Stars

Company-stated result if the 20 measures were included

HEDIS score

4.82 out of 5 Stars

Core measures; stated as consistent regardless of the CMS methodology used for 2027

Peer-group ranking

#1

Among non-SNP PPO plans with over 2,000 members on core HEDIS measures

Key Terms

hedis, ppo, hmo

3 terms

hedis medical

"core Healthcare Effectiveness Data and Information Set (HEDIS®)"

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.

ppo technical

"its PPO Medicare Advantage (“MA”) plans a rating of 5 Stars"

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.

hmo technical

"its HMO MA plan a rating of 4.5 Stars"

HMO stands for Health Maintenance Organization, a type of managed health insurance plan that gives members access to a network of doctors and hospitals for a fixed premium and generally requires using in-network providers or referrals for specialists. Investors watch HMO performance because membership levels, cost controls and care network agreements directly affect revenue, profit margins and regulatory exposure—think of it as a subscription service that must balance member satisfaction with cost containment.

AI-generated analysis. How Rhea-AI works. Not financial advice.

See more from StockTitan in Google Search and AI answers. Adds StockTitan as a preferred source · opens Google

Add on Google Not now

Star ratings support Clover’s continued ability to offer market-leading and low out-of-pocket costs for members

WILMINGTON, Del., Oct. 08, 2026 (GLOBE NEWSWIRE) -- Clover Health Investments, Corp. (Nasdaq: CLOV) (“Clover,” “Clover Health” or the “Company”), today announced that the Centers for Medicare & Medicaid Services (“CMS”) has awarded its PPO Medicare Advantage (“MA”) plans a rating of 5 Stars and its HMO MA plan a rating of 4.5 Stars for 2027, which will affect payment year 2028. Through the first half of 2026, Clover Health grew Medicare Advantage membership ~48% year-over-year to more than 157,000 members, with ~98% enrolled in its wide-network PPO plans. At 5 Stars, Clover’s PPO plans will be able to enroll beneficiaries year round.

Each year, CMS assigns Star ratings to Medicare Advantage and Part D contracts on its healthcare quality and drug plan, and issues a Star rating on a scale of 1 to 5 Stars. These ratings affect payments to Medicare Advantage plans. For the 2027 Star Ratings, Clover’s overall Star rating was driven by improvements across Stars domains.

In light of the decision in Clover Insurance Company v. Department of Health & Human Services, Civ. A. No. 25-142 (S.D. Ga.) issued on May 27, 2026, which is on appeal, CMS calculated Clover’s rating for its PPO plans removing the 20 measures included in the court decision, awarding Clover’s PPO plans 5 Stars. With the 20 measures included, Clover’s PPO plans would have received 4.5 Stars.

Additionally, for the third year in a row, Clover has continued its market-leading performance on core Healthcare Effectiveness Data and Information Set (“HEDIS®”¹) measures with a score of 4.82 out of 5 Stars², again ranking #1 among non-SNP PPO plans with over 2,000 members. HEDIS is a set of performance measures used to assess aspects of care quality, including preventive screenings and management of health issues such as diabetes, cancer, and heart disease. Clover’s HEDIS score remains consistent at 4.82 out of 5 Stars regardless of the CMS methodology used for 2027, demonstrating the strength of a care model powered by Counterpart Assistant that surfaces relevant information for physicians to identify care needs and support better-informed clinical decisions.

“Success in the Star ratings system means an enhanced ability to support our members and to continue to provide them market leading plans. We also continue to support reforms to the Stars program that more closely align these ratings with meaningful improvements in members’ health and value for the Medicare program,” said Andrew Toy, CEO of Clover Health. “We are particularly proud of our core HEDIS measures performance, which assess important aspects of preventive care and chronic disease management. Our focus remains on giving physicians the tools to deliver proactive care across our wide PPO network, supported by our Counterpart Assistant platform.”

“Our teams have worked incredibly hard over the last several years, and we’re excited about what this year’s Star rating means for our ability to keep delivering the benefits, affordability, and wide choice of providers that our members count on and trust,” said Jamie Reynoso, CEO of Medicare Advantage, Clover Health. “With a higher Star rating, we are able to further reinvest in even more competitive benefits. This milestone allows us to scale our impact to more people on Medicare without compromising our financial strength or commitment to care quality.”

“We founded Clover with the conviction that improving healthcare requires both the ambition to reimagine it coupled with the willingness to solve hard problems, on a first principles basis,” added Vivek Garipalli, Founder and Executive Chairman of Clover Health. “I’m proud to work closely with our teams on critical aspects of these efforts, and I have a ton of fun doing so as well. This Star rating reflects many, many years of persistence and disciplined execution and provides a strong opportunity to build on that foundation moving forward as we continue to seek much-needed reforms.”

To learn more about Clover Health and its Medicare Advantage plans, visit www.cloverhealth.com. For providers, health systems and plans interested in learning about how they can use Clover’s proprietary technology stack to succeed in value-based care, visit www.counterparthealth.com.

Federal Contracting Disclaimer: Clover Health is a Preferred Provider Organization (PPO) and a Health Maintenance Organization (HMO) with a Medicare contract. Enrollment in Clover Health depends on contract renewal.

The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.

Forward-Looking Statements:

Please note that 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, its anticipated financial results associated with CMS’ 2027 Stars ratings of 5.0 for Clover’s PPO MA plans and its 2027 Stars rating of 4.5 for Clover’s HMO plan, future financial outlook, future membership growth and retention, Clover assistant usage and investment, and cost efficiency initiatives, as well as our expectations related to Clover’s GAAP and Adjusted EBITDA profitability, 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. 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 February 27, 2026, 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

Y0129_26EX091D_C

---

¹ HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)
² This analysis focuses on performance by non-SNP PPO plans with over 2,000 lives as of September 1, 2024, 2025, and 2026 on HEDIS measures applicable to non-SNPs that were used for CMS’s MY 2023, MY 2024, and MY 2025 Star ratings, applying the measure ranges used by CMS.

FAQ

AI-generated questions and answers. How Rhea-AI works. Not financial advice.

What Medicare Advantage Star ratings did Clover Health receive for 2027?

Clover Health received 5 Stars for its PPO plans and 4.5 Stars for its HMO plan for 2027. These ratings affect payment year 2028. The 5-Star PPO rating also enables the plans to enroll beneficiaries year round.

How did the court decision affect Clover Health’s 2027 PPO Star rating?

CMS excluded 20 measures covered by the May 27, 2026 court decision when calculating Clover’s 5-Star PPO rating. The decision is on appeal. With those measures included, the PPO plans would have received 4.5 Stars; the core HEDIS score remains 4.82 out of 5 Stars under either methodology.