The 5-Star rating is a significant catalyst for Clover's 2028 revenue outlook. Monitor the appeal of the court ruling — if overturned, the PPO rating would revert to 4.5 Stars, reducing the financial benefit. Also watch for competitor Star rating announcements and any CMS policy changes affecting the Star ratings program.
Price Chart
Executive Summary
Clover Health announced that CMS awarded its PPO Medicare Advantage plans a 5-Star rating and its HMO plan a 4.5-Star rating for 2027 (affecting payment year 2028). The 5-Star rating for PPO plans was calculated excluding 20 measures per a court ruling (currently on appeal); with those measures included, the PPO plans would have received 4.5 Stars. The 5-Star rating enables year-round enrollment and higher CMS payments, a material positive for Clover's revenue and competitive positioning.
Key Facts
- CMS awarded Clover's PPO MA plans a 5-Star rating for 2027 (payment year 2028).
- CMS awarded Clover's HMO MA plan a 4.5-Star rating for 2027.
- The 5-Star PPO rating was calculated excluding 20 measures per a court ruling (Clover Insurance Company v. HHS, on appeal); with those measures included, PPO plans would have received 4.5 Stars.
- Clover grew Medicare Advantage membership 48% year-over-year in H1 2026 to over 157,000 members, with 98% enrolled in PPO plans.
- At 5 Stars, Clover's PPO plans can enroll beneficiaries year-round.
- Clover's core HEDIS score remained at 4.82 out of 5 Stars for the third consecutive year, ranking #1 among non-SNP PPO plans with over 2,000 members.
Financial Impact
5-Star rating unlocks higher CMS reimbursement rates and year-round enrollment, directly boosting revenue per member and membership growth. The 48% YoY membership growth to 157k+ members provides a large base for the enhanced payment.
Risk Factors
- The 5-Star PPO rating is contingent on a court ruling that is on appeal; reversal would drop the rating to 4.5 Stars.
- Star ratings are subject to annual recalculation; maintaining 5 Stars in future years is not guaranteed.
- Enrollment growth and revenue impact depend on plan renewal and competitive dynamics.
Investment Themes
Documents Analyzed
This report is based on 5 SEC documents filed with EDGAR.
| Document | Accession Number |
|---|---|
| 8-K Filing (Primary) | 0001801170-26-000250 |
| Document: axex991xpressreleasedated1.htm | 0001801170-26-000250 |
| Document: 0001801170-26-000250-index-headers.html | 0001801170-26-000250 |
| Document: 0001801170-26-000250-index.html | 0001801170-26-000250 |
| Document: 0001801170-26-000250.txt | 0001801170-26-000250 |
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Oct 20, 2026 7d ago | Insider Cluster | $4.78 $4.73 | ▲ +1.05% | ▼ −0.13% | $4.63 (+3.14%) |
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