Clover Health Medicare Advantage PPO Plans Earn 5-Star Rating; HMO at 4.5 Stars
Clover Health's PPO Medicare Advantage plans received a 5.0 Star rating and HMO plans 4.5 Stars for 2027, impacting 2028 payments. CMS removed 20 measures for PPO plans, raising their rating. Clover's MA membership grew ~48% YoY to >157,000 members, with 98% in PPO plans. The company ranked #1 among non-SNP PPO plans with >2,000 members on core HEDIS measures, scoring 4.82 out of 5.
How this was made
The 30-second read
Why it matters
The 5‑star rating is a key quality metric that drives higher Medicare reimbursements, likely boosting earnings forecasts.
Market read
First disclosure of a top rating for Clover Health, creating a clear catalyst for the stock.
What to watch
Potential for future CMS policy changes or litigation affecting rating methodology.
Background
Clover Health filed an 8‑K reporting the new CMS star ratings for its Medicare Advantage plans.
Ticker impact
CMS awarded Clover Health's PPO plans a 5‑star rating and HMO plans 4.5 stars for 2027, a new regulatory rating that impacts 2028 payments.
likely upward pressure as investors price in higher Medicare Advantage payments.
First‑report of a 5‑star rating, which historically correlates with share gains for Medicare Advantage insurers.
Market effects
May lift other Medicare Advantage providers as investors reassess rating risk.
US healthcare sector could see modest upside.
Limited to US health‑insurance space.
Counterpoint
Rating could be temporary if CMS revises measures later; price may already be priced in.
Key entities
- companyClover Health
US‑listed Medicare Advantage insurer (ticker CLOV).
- regulatorCMS
Centers for Medicare & Medicaid Services, issuer of the star ratings.
