Clover Health Investments, Corp. disclosed that the Centers for Medicare & Medicaid Services (CMS) has recalculated and upgraded the Star Ratings for two of its Medicare Advantage contracts. These upgrades to 4.5 Stars are expected to positively impact Quality Bonus Payments for the 2027 payment year.
Key Details
- PPO Contract (H5141): The 2026 Star Rating was officially increased from 3.5 Stars to 4.5 Stars.
- HMO Contract (H8010): The 2026 Star Rating was increased from 4.0 Stars to 4.5 Stars.
- Financial Impact: The upgraded ratings apply to the 2027 payment year, which determines eligibility for Quality Bonus Payments from CMS.
- Background: The recalculations follow a broader CMS guidance update, which was prompted by a court judgment related to Clover's PPO plan.