Clover Health said on October 8, 2026 that the Centers for Medicare & Medicaid Services, or CMS, gave its PPO Medicare Advantage plans a 5-star rating for 2027 and its HMO Medicare Advantage plan a 4.5-star rating, with the result affecting payment year 2028. The company said the 5-star PPO rating will allow those plans to enroll beneficiaries year round.

The company said that through the first half of 2026, Medicare Advantage membership grew about 48% year over year to more than 157,000 members, and that about 98% of those members were enrolled in its wide-network PPO plans.

Clover said CMS awards Star ratings each year on a scale of 1 to 5 stars for Medicare Advantage and Part D contracts, and that those ratings affect payments to Medicare Advantage plans. For 2027, the company said its overall rating was driven by improvements across Star domains.

The company also said that, because of the decision in Clover Insurance Company v. Department of Health & Human Services, issued on May 27, 2026 and now on appeal, CMS calculated its PPO rating without 20 measures included in that court decision. Clover said that approach produced the 5-star result, while including the 20 measures would have left the PPO plans at 4.5 stars.

Clover said its core Healthcare Effectiveness Data and Information Set, or HEDIS, score was 4.82 out of 5 stars for a third consecutive year and ranked first among non-SNP PPO plans with more than 2,000 members. HEDIS is a set of measures used to assess care quality, including preventive screenings and management of issues such as diabetes, cancer and heart disease.

Andrew Toy, Clover Health’s chief executive, said: “Success in the Star ratings system means an enhanced ability to support our members and to continue to provide them market leading plans.” Jamie Reynoso, CEO of Medicare Advantage at Clover Health, said: “With a higher Star rating, we are able to further reinvest in even more competitive benefits.” Vivek Garipalli, founder and executive chairman, said the rating “reflects many, many years of persistence and disciplined execution.”

Clover Health said it is a physician enablement technology company that offers PPO and HMO Medicare Advantage plans in several states, with a focus on its wide-network PPO plans.

Highlights

  • CMS gave Clover Health’s PPO Medicare Advantage plans a 5-star rating for 2027.
  • Its HMO Medicare Advantage plan received a 4.5-star rating.
  • A 5-star PPO rating allows year-round enrollment.
  • Clover said it had more than 157,000 Medicare Advantage members in the first half of 2026.