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  "id": "clover-health",
  "name": "Clover Health",
  "kind": "company",
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  "same_as": [],
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    {
      "slug": "medicare-advantage-2027",
      "title": "Medicare Advantage's Retreat: From the 2026 Rate Hike to the 2027 Plan Exits and Open Enrollment",
      "url": "https://whatledto.com/events/medicare-advantage-2027",
      "json": "https://whatledto.com/events/medicare-advantage-2027.json",
      "role": "Won a district-court ruling against aspects of CMS's star methodology, obtained a recalculated rating, and is defending that ruling on appeal.",
      "entries": 6,
      "updated_at": "2026-10-14T02:01:40.262749+00:00"
    }
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      "timeline": "medicare-advantage-2027",
      "id": 2137,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n2137",
      "date": "2026-10-08",
      "date_precision": "day",
      "title": "Clover Health says its PPO MA plans earned five stars for 2027",
      "summary": "Clover Health said CMS awarded its PPO Medicare Advantage plans five stars and its HMO plan 4.5 stars for 2027. Clover Health said the ratings would affect payment year 2028.",
      "type": "announcement",
      "entities": [
        "Clover Health",
        "CMS",
        "Medicare Advantage"
      ],
      "parties": [
        "clover-health",
        "cms",
        "medicare-advantage"
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        {
          "url": "https://investors.cloverhealth.com/news-releases/news-release-details/clover-health-medicare-advantage-ppo-plans-earn-5-star-rating",
          "outlet": "Clover Health",
          "published": "2026-10-08",
          "quote": "Clover Health Investments, Corp. (Nasdaq: CLOV) (“Clover,” “Clover Health” or the “Company”), today announced that the Centers for Medicare & Medicaid Services (“CMS”) has awarded its PPO Medicare Advantage (“MA”) plans a rating of 5 Stars and its HMO MA plan a rating of 4.5 Stars for 2027, which will affect payment year 2028."
        }
      ]
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    {
      "timeline": "medicare-advantage-2027",
      "id": 640,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n640",
      "date": "2026-07-21",
      "date_precision": "day",
      "title": "CMS files notice appealing Clover star-ratings ruling",
      "summary": "CMS filed a notice of appeal to the U.S. Court of Appeals for the Eleventh Circuit against the May ruling that it had exceeded its authority on ten star-ratings measures, according to Clover's 10-Q and a Becker's report citing a July 21 court filing; the appellate docket shows the case opened July 22. CMS had meanwhile recalculated Clover's rating to 4.5 stars and begun recalculating other 2027 quality-bonus ratings.",
      "type": "legal",
      "entities": [
        "Centers for Medicare & Medicaid Services",
        "Department of Health and Human Services",
        "Clover Health",
        "U.S. Court of Appeals for the Eleventh Circuit"
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      "sources": [
        {
          "url": "https://www.sec.gov/Archives/edgar/data/1801170/000180117026000200/clov-20260630.htm",
          "outlet": "Clover Health Form 10-Q",
          "published": "2026-08-05",
          "quote": "On July 21, 2026, CMS filed its Notice of Appeal of the district court's decision in the Stars Litigation with the United States Court of Appeals for the Eleventh Circuit."
        },
        {
          "url": "https://www.beckershospitalreview.com/legal-regulatory-issues/cms-appeals-clovers-medicare-advantage-star-ratings-win/",
          "outlet": "Becker’s Hospital Review",
          "published": "2026-07-22",
          "quote": "The case will now move to the U.S. Court of Appeals for the Eleventh Circuit, according to a July 21 court filing."
        },
        {
          "url": "https://litigationtracker.law.georgetown.edu/litigation/clover-insurance-company-v-department-of-health-and-human-services-et-al-2/",
          "outlet": "Georgetown Law Health Care Litigation Tracker",
          "published": null,
          "quote": "Date Filed July 22, 2026"
        }
      ]
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    {
      "timeline": "medicare-advantage-2027",
      "id": 651,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n651",
      "date": "2026-07-01",
      "date_precision": "day",
      "title": "Elevance Health sues HHS and CMS over star-ratings recalculation",
      "summary": "Elevance Health sued the Department of Health and Human Services and the Centers for Medicare & Medicaid Services over the recalculation of Medicare Advantage quality ratings. Elevance Health alleged that the recalculation did not align with the Clover Health ruling and affected $115 million in payments.",
      "type": "legal",
      "entities": [
        "Elevance Health",
        "Department of Health and Human Services",
        "Centers for Medicare & Medicaid Services",
        "Clover Health"
      ],
      "parties": [
        "elevance-health",
        "department-of-health-and-human-services",
        "centers-for-medicare-medicaid-services",
        "clover-health"
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      "sources": [
        {
          "url": "https://docs.justia.com/cases/federal/district-courts/georgia/gasdce/2%3A2026cv00061/128226/45",
          "outlet": "U.S. District Court for the Southern District of Georgia order, reproduced by Justia",
          "published": "2026-08-27",
          "quote": "Plaintiffs filed the instant action on July 1, 2026."
        },
        {
          "url": "https://www.statnews.com/2026/07/02/elevance-lawsuit-medicare-advantage-star-ratings-clover/",
          "outlet": "STAT",
          "published": "2026-07-02",
          "quote": "Elevance Health has sued the U.S. government, alleging that federal efforts to recalculate its Medicare Advantage quality ratings didn’t align with a recent court ruling, costing the health insurer $115 million."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 638,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n638",
      "date": "2026-06-17",
      "date_precision": "day",
      "title": "CMS begins recalculating certain 2027 quality bonus ratings",
      "summary": "CMS issued guidance that it was voluntarily recalculating 2027 Quality Bonus Payment ratings for certain Medicare Advantage contracts. CMS said the recalculation resulted from the preceding court decision.",
      "type": "regulatory",
      "entities": [
        "Centers for Medicare & Medicaid Services",
        "Clover Health"
      ],
      "parties": [
        "centers-for-medicare-medicaid-services",
        "clover-health"
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      "sources": [
        {
          "url": "https://www.sec.gov/Archives/edgar/data/1801170/000180117026000166/clov-20260617.htm",
          "outlet": "Clover Health Form 8-K",
          "published": "2026-06-18",
          "quote": "On June 17, 2026, CMS issued updated guidance informing all Medicare Advantage Organizations that it was voluntarily recalculating the 2027 Quality Bonus Payment ratings for certain Medicare Advantage contracts as a result of the preceding decision."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 637,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n637",
      "date": "2026-06-09",
      "date_precision": "day",
      "title": "CMS recalculates Clover rating to 4.5 stars",
      "summary": "CMS informed Clover that it had recalculated Clover's 2026 Star Rating to 4.5 stars. CMS instructed Clover to submit alternate bids using the 4.5-star rating.",
      "type": "regulatory",
      "entities": [
        "Centers for Medicare & Medicaid Services",
        "Clover Health"
      ],
      "parties": [
        "centers-for-medicare-medicaid-services",
        "clover-health"
      ],
      "sources": [
        {
          "url": "https://www.sec.gov/Archives/edgar/data/1801170/000180117026000137/clov-20260609.htm",
          "outlet": "Clover Health Form 8-K",
          "published": "2026-06-10",
          "quote": "On June 9, 2026, CMS informed Clover that, consistent with the Court’s order, it has recalculated Clover's 2026 Star Rating as 4.5 Stars, and has instructed Clover to submit alternate bids at 4.5 Stars."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 631,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n631",
      "date": "2026-05-27",
      "date_precision": "day",
      "title": "Clover wins a ruling that CMS exceeded its authority on ten star-ratings measures",
      "summary": "A federal district court granted Clover Insurance partial summary judgment, holding that CMS exceeded its statutory authority in calculating ten star measures and skipped notice-and-comment on ten more, the second court in a year to upend the ratings. Humana cited the decision in its pending Fifth Circuit appeal a week later.",
      "type": "legal",
      "entities": [
        "Clover Health",
        "Centers for Medicare & Medicaid Services",
        "Humana"
      ],
      "parties": [
        "clover-health",
        "centers-for-medicare-medicaid-services",
        "humana"
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      "sources": [
        {
          "url": "https://www.groom.com/resources/oh-my-stars-a-federal-court-again-upends-cmss-medicare-advantage-ratings/",
          "outlet": "Groom Law Group",
          "published": "2026-05-28",
          "quote": "On May 27, 2026, a federal district court granted partial summary judgment for Clover Insurance Company (“Clover”), holding that CMS exceeded its statutory authority in calculating ten Star Ratings measures and separately failed to satisfy notice-and-comment rulemaking requirements for ten other measures."
        }
      ]
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