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Court Win Forces CMS to Raise Clover Health Medicare Star Rating to 4.5

The higher score secures Clover’s access to larger 2027 Medicare Advantage quality bonus payments tied to star ratings.

Overview

  • A federal judge ordered CMS to recalculate Clover’s plan score on May 29, and CMS formally notified Clover on June 9 that Contract H5141 had been revised to 4.5 stars.
  • The revised rating applies to Contract H5141, Clover’s PPO Medicare Advantage plan that covers roughly 97% of the company’s members.
  • A 4.5 score changes Clover’s 2027 payment profile because CMS ties higher star ratings to larger reimbursement adjustments and eligibility for quality bonus payments that the company says amount to millions.
  • Investors reacted immediately: Clover shares jumped about 14%, hitting an intraday peak near $5.14 and closing at $4.89, while analysts pointed to the ruling plus improving Q1 fundamentals as reasons to raise optimism.
  • Medicare star ratings directly affect plan revenue and market competitiveness, so this court-driven revision could alter Clover’s growth path and set a precedent for judicial review of CMS rating methods.