Forex News
Clover Health gets 5-star CMS rating for PPO plans
Clover Health said CMS gave its PPO Medicare Advantage plans a 5-star rating for 2027, affecting payment year 2028.
- Clover’s HMO MA plan received a 4.5-star rating for 2027.
- CMS said the ratings affect payments to Medicare Advantage plans.
- Clover said 98% of its Medicare Advantage members were enrolled in its wide-network PPO plans in the first half of 2026.
Clover Health said on Thursday that CMS awarded its PPO Medicare Advantage plans a 5-star rating for 2027. The rating will affect payment year 2028.
The company said its HMO Medicare Advantage plan received a 4.5-star rating for 2027. CMS rates Medicare Advantage and Part D contracts on a scale of 1 to 5 stars.
Clover said CMS removed 20 measures from the calculation under the court decision in Clover Insurance Company v. Department of Health & Human Services, issued on May 27, 2026 and now on appeal. With those measures included, Clover said its PPO plans would have received 4.5 stars.
Membership and performance
Through the first half of 2026, Clover Health said Medicare Advantage membership grew about 48% year over year to more than 157,000 members. It said about 98% were enrolled in its wide-network PPO plans.
Clover also said its core HEDIS score was 4.82 out of 5 stars for the third year in a row. It said that ranked it No. 1 among non-SNP PPO plans with more than 2,000 members.
Success in the Star ratings system means an enhanced ability to support our members and to continue to provide them market leading plans.
— Andrew Toy, CEO of Clover Health
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.
— Jamie Reynoso, CEO of Medicare Advantage, Clover Health
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.
— Vivek Garipalli, founder and executive chairman of Clover Health
Clover said its PPO plans will be able to enroll beneficiaries year round at 5 stars.
The company also said the higher rating allows it to reinvest in more competitive benefits. It said it wants to scale its impact to more people on Medicare without compromising financial strength or care quality.
Federal contracting language in the release said Clover Health is a PPO and an HMO with a Medicare contract, and that enrollment depends on contract renewal.
Source: GlobeNewswire,