Elevance challenges CMS over Medicare Advantage rating methodology
Elevance Health filed a complaint against CMS and HHS over the calculation of its 2027 Medicare Advantage ratings. The insurer alleges that 11 measures were adopted improperly and depressed results for 12 contracts, with corrected scores increasing each by at least half a star. Elevance says the disputed methodology could affect approximately $516 million in 2028 quality bonus payments and rebate retention.
Why it matters
If the court grants Elevance’s requested relief, CMS would need to recalculate the affected ratings and use the revised results when determining 2028 payments and rebates. The company’s complaint also says the ratings can influence plan visibility to members, brokers and employers, but the allegations have not been decided.
Key facts
- 1Elevance filed the case against CMS and HHS on November 6, 2026, in the U.S. District Court for the District of Columbia. insurancebusinessmag.com
- 2The complaint challenges 11 measures used across 12 Elevance contracts in calculating the 2027 ratings. insurancebusinessmag.com
- 3Elevance estimates that correcting the ratings could produce approximately $516 million in 2028 quality bonus payments and rebate retention. insurancebusinessmag.com
- 4The insurer alleges that removing the disputed measures would lift every affected contract by at least half a star. news.ssbcrack.com
- 5Elevance is asking the court to invalidate the affected 2027 ratings, require a new calculation, and base 2028 payments and rebates on the revised results. news.ssbcrack.com
Open questions
- No court has ruled on the merits of Elevance’s allegations, and the approximately $516 million estimate depends on the requested rating correction.
Summary written by AlphAI AI Desk from 2 of 2 sources. Not investment advice. Figures are as stated by the linked sources.