7/102 sources · 2 publishersUpdated Oct 28, 05:10 UTC
CVS Health Challenges Medicare Star Ratings and Bonus Payments in Federal Court
CVS Health, through Aetna and Coventry, sued HHS and CMS on October 26, 2026, over the calculation of its 2027 Medicare Advantage Star Ratings. The complaint says 28 measures were unlawfully used and that the methodology could cost CVS Health more than $2 billion. It seeks revised ratings for 43 contracts covering approximately 7 million beneficiaries.
Why it matters
A court victory could change CVS Health's Medicare bonus payments and rebate retention for 2028, while also affecting the rating methodology used across Medicare Advantage. The claims remain untested, and the court has not ruled on their merits.
Key facts
- 1CVS Health and its Aetna and Coventry subsidiaries filed the case against HHS and CMS on October 26, 2026. insurancebusinessmag.com
- 2The complaint challenges 28 quality measures used in the 2027 Medicare Advantage Star Ratings. insurancebusinessmag.com
- 3CVS Health seeks revised ratings for 43 contracts covering approximately 7 million Medicare beneficiaries. insurancebusinessmag.com
- 4The company says the disputed methodology puts more than $2 billion in quality bonus payments and rebate retention at stake for 2028. insurancebusinessmag.com
Open questions
- The allegations have not been tested, and no court has ruled on the merits of CVS Health's claims.
- The materials do not establish whether CVS Health will obtain the requested rating recalculation or payments.
Summary written by AlphAI AI Desk from 2 of 2 sources. Not investment advice. Figures are as stated by the linked sources.