Clover Health Investments, Corp. announced on October 8, 2026, that the Centers for Medicare & Medicaid Services (CMS) has awarded its Medicare Advantage (MA) plans specific ratings for the 2027 program year, which will impact payment year 2028. CMS awarded Clover’s Preferred Provider Organization (PPO) MA plans a rating of 5 Stars, while its Health Maintenance Organization (HMO) MA plan received a rating of 4.5 Stars.
The company noted that the 5-Star rating for its PPO plans is a result of CMS removing 20 specific measures included in a court decision, Clover Insurance Company v. Department of Health & Human Services, which is currently on appeal. Had those 20 measures been included in the calculation, the PPO plans would have received a 4.5-Star rating.
Clover reported that through the first half of 2026, its Medicare Advantage membership grew approximately 48% year-over-year to more than 157,000 members. Of these members, approximately 98% are enrolled in the wide-network PPO plans. The 5-Star rating allows these PPO plans to enroll beneficiaries year-round.
In addition to the CMS ratings, Clover Health achieved a Healthcare Effectiveness Data and Information Set (HEDIS) score of 4.82 out of 5 Stars for the third consecutive year. This score ranked the company number one among non-Special Needs Plan (non-SNP) PPO plans with over 2,000 members.
Company leadership, including CEO Andrew Toy, Executive Chairman Vivek Garipalli, and CEO of Medicare Advantage Jamie Reynoso, commented on the ratings. They emphasized the ratings' role in supporting the ability to offer market-leading plans and reinvest in benefits, while noting the company’s focus on reforms to the Star ratings program.
