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High materiality8/10

Clover Health earns 5-Star PPO and 4.5-Star HMO CMS ratings for 2027

Oct 8, 2026, 6:52 PM EDT1 sourcesAI-analyzed
Why it may matterVerify against the original reporting

Higher CMS star ratings translate into higher payments and broader enrollment for Clover's PPOs; coupled with robust HEDIS performance and strong PPO-dominant membership, this could re-rate Cox's Medicare Advantage economics in the near term. The key caveat is the ongoing legal ruling could alter the star calculation if the appeal changes the methodology.

AI summary

What happened, with direct paths to the underlying reporting

CMS awarded Clover Health 5-Star for its PPO MA and 4.5-Star for its HMO MA for 2027, with payments applying in 2028. Through 1H2026, Clover MA membership rose 48% YoY to over 157,000, about 98% in PPO plans, supporting year-round enrollment. The company posts a 4.82/5 HEDIS score, reinforcing care quality and Counterpart Assistant's relevance, which could translate into higher funding and stronger competitive positioning.

  • CMS awards Clover PPO 5.0 Stars and HMO 4.5 Stars for 2027.
  • 1H2026 MA membership up ~48% YoY to >157,000; ~98% in PPO.
  • PPO plans enroll beneficiaries year-round at 5 Stars.
  • HEDIS score 4.82/5; top non-SNP PPO >2,000 lives.
  • CMS star calculation affected by Clover v. DHHS ruling; 20 measures removed.

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