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Clover Health ได้ 5 ดาวจาก CMS สำหรับแผน PPO ปี 2027
Clover Health ระบุว่า CMS ให้คะแนนแผน PPO Medicare Advantage เป็น 5 ดาวสำหรับปี 2027 และแผน HMO เป็น 4.5 ดาว
หน้านี้เป็นฉบับภาษาไทย เขียนขึ้นจากข้อเท็จจริงชุดเดียวกับฉบับภาษาอังกฤษ ไม่ใช่คำแปล อ่านฉบับภาษาอังกฤษ
- คะแนน 5 ดาวของแผน PPO มีผลต่อปีจ่าย 2028
- หากนับ 20 มาตรวัดในคดี PPO จะได้ 4.5 ดาว
- ครึ่งแรกปี 2026 สมาชิก Medicare Advantage เพิ่มราว 48% แตะมากกว่า 157,000 ราย
Clover Health Investments announced on 8 Oct. 2026 that the Centers for Medicare & Medicaid Services awarded its PPO Medicare Advantage plans 5 Stars for 2027. The company said the HMO MA plan received 4.5 Stars, and that the rating will affect payment year 2028.
Clover said the PPO plans will be able to enroll beneficiaries year round at 5 Stars. It also said Medicare Advantage membership grew about 48% year over year in the first half of 2026 to more than 157,000 members, with about 98% in its wide-network PPO plans.
คะแนนและคดี
CMS calculates Star ratings for Medicare Advantage and Part D contracts on a 1-to-5 scale. Clover said its overall 2027 Star rating was driven by improvements across Star domains.
The company said CMS removed 20 measures tied to Clover Insurance Company v. Department of Health & Human Services, a case issued on 27 May 2026 and now on appeal, when it calculated the PPO rating. With those 20 measures included, Clover said the PPO plans would have received 4.5 Stars.
HEDIS performance
Clover said its core HEDIS score was 4.82 out of 5 Stars for a third straight year. It said the score again ranked first among non-SNP PPO plans with more than 2,000 members.
The company said the HEDIS score stayed at 4.82 out of 5 Stars regardless of the CMS methodology used for 2027. It said the result reflects a care model powered by Counterpart Assistant.
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
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.
— Vivek Garipalli, Founder and Executive Chairman of Clover Health
Clover said its PPO and HMO Medicare Advantage plans are offered under a Medicare contract. It said enrollment depends on contract renewal.
ที่มา: GlobeNewswire,