Clover Health CMS Star Ratings raised to 4.5 Stars
Clover Health Investments reported that the Centers for Medicare & Medicaid Services (CMS) has increased key quality ratings for its Medicare Advantage plans, which affect payments for 2027.
Rhea-AI Filing Summary
Clover Health Investments reported that the Centers for Medicare & Medicaid Services (CMS) has increased key quality ratings for its Medicare Advantage plans, which affect payments for 2027. CMS now shows the company’s PPO contract H5141 at 4.5 Stars for payment year 2027, up from 3.5 Stars in the 2026 Star Rating.
In addition, CMS’s updated guidance and system display that the 2026 Star Rating for Clover’s HMO contract H8010 has risen from 4.0 Stars to 4.5 Stars, also impacting payment year 2027 Quality Bonus Payments. These higher star ratings can support stronger revenue potential and competitiveness in the Medicare Advantage market.
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Insights
CMS upgrades Clover’s star ratings to 4.5 Stars on key Medicare Advantage contracts, improving 2027 payment potential.
The filing explains that CMS recalculated Clover Health’s Medicare Advantage Star Ratings after a court judgment in Clover Insurance Co. v. HHS. The PPO contract H5141 was raised from 3.5 to 4.5 Stars for payment year 2027, and the HMO contract H8010 from 4.0 to 4.5 Stars.
Star Ratings help determine Quality Bonus Payments, so moving both contracts to 4.5 Stars can enhance reimbursement and marketing advantages relative to lower-rated plans. The guidance notes that updated 2027 Quality Bonus Payment ratings are available in the Health Plan Management System, giving operational clarity for Clover’s 2027 Medicare Advantage revenue framework.
8-K Event Classification
Key Figures
Key Terms
Centers for Medicare & Medicaid Services regulatory
Star Rating regulatory
Quality Bonus Payment financial
Medicare Advantage financial
Health Plan Management System (HPMS) technical
FAQ
AI-generated questions and answers. How Rhea-AI works. Not financial advice.
How did CMS change Clover Health (CLOV) Star Ratings for 2027?
Which Clover Health (CLOV) contracts received 4.5 Star Ratings?
What prior Star Ratings did Clover Health (CLOV) contracts have?
Why are Clover Health (CLOV) Star Ratings important for 2027 payments?
What triggered CMS to recalculate Clover Health (CLOV) ratings?
AI-generated analysis. How Rhea-AI works. Not financial advice.