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# Clover's 5-Star PPO Rating Holds Only Because CMS Dropped 20 Measures; Counted, It Is 4.5 Stars
- URL: https://www.bullished.co/clovers-5-star-ppo-rating-holds-only-because-cms-dropped-20-measures-counted-it-is-4-5-9f2263ec/
- Published: 2026-10-09T10:17:09.000Z
- Updated: 2026-10-09T10:17:09.000Z
- Description: The 5-star score depends on a May 27 federal ruling that is on appeal, and Clover's HMO plan got 4.5 stars.
- Author: Matteo Parrino
- Tags: SEC Filings, CLOV, Industry: Healthcare

Clover Health's PPO Medicare Advantage plans earned [5 stars for 2027](https://www.sec.gov/Archives/edgar/data/0001801170/000180117026000250/clov-20261008.htm?ref=bullished.co), but only because regulators left out 20 measures covered by a court ruling that is under appeal, according to an 8-K the company filed Thursday. With those measures counted, the PPO plans would have received 4.5 stars.

## What the 8-K says

The Centers for Medicare & Medicaid Services (CMS) gave [Clover's PPO plans 5 stars](https://www.marketwatch.com/story/clover-health-investments-climbs-after-ppo-medicare-advantage-plans-rated-five-stars-00b8be34?ref=bullished.co) and [its HMO plan 4.5 stars](https://www.marketwatch.com/story/clover-health-investments-climbs-after-ppo-medicare-advantage-plans-rated-five-stars-00b8be34?ref=bullished.co). The ratings affect payment year 2028, and CMS assigns them on a scale of 1 to 5 stars.

The PPO score reflects a decision in Clover Insurance Company v. Department of Health & Human Services, issued May 27, 2026, in the Southern District of Georgia. In light of that ruling, which is on appeal, CMS calculated the PPO rating without the 20 measures it covered, according to the filing and the [company's press release](https://www.globenewswire.com/news-release/2026/10/08/3377770/0/en/clover-health-medicare-advantage-ppo-plans-earn-5-star-rating-for-2027.html?ref=bullished.co).

The company said its overall rating was driven by improvements across Stars domains.

## Why the rating matters to Clover

At 5 stars, Clover said, its PPO plans can enroll beneficiaries year round. Through the first half of 2026, membership grew about 48% year over year to [more than 157,000](https://www.globenewswire.com/news-release/2026/10/08/3377770/0/en/clover-health-medicare-advantage-ppo-plans-earn-5-star-rating-for-2027.html?ref=bullished.co), with about 98% in its wide-network PPO plans.

Jamie Reynoso, CEO of Medicare Advantage at Clover, said a higher rating lets the company "further reinvest in even more competitive benefits."

Clover also pointed to a separate quality score. It said it scored 4.82 out of 5 on core HEDIS measures, a set of care-quality gauges covering preventive screenings and chronic conditions such as diabetes. That is the third year in a row, and it ranks first among non-SNP PPO plans with over 2,000 members. The company said the score holds regardless of the CMS methodology used for 2027.

## What to watch

The appeal of the Georgia ruling decides whether the 20 measures count toward the PPO rating. CEO Andrew Toy said the company continues to support reforms to the Stars program that "more closely align these ratings with meaningful improvements in members' health and value for the Medicare program."

Clover's PPO plans carry about 98% of its membership, so the rating rests on a court decision still being appealed.

### Sources

- [8-K Filing — CLOVER HEALTH INVESTMENTS, CORP. /DE (CLOV)](https://www.sec.gov/Archives/edgar/data/0001801170/000180117026000250/clov-20261008.htm?ref=bullished.co) — SEC EDGAR
- [Exhibit axex991xpressreleasedated1.htm — CLOVER HEALTH INVESTMENTS, CORP. /DE 8-K exhibit](https://www.sec.gov/Archives/edgar/data/0001801170/000180117026000250/axex991xpressreleasedated1.htm?ref=bullished.co) — SEC EDGAR
- [Clover Health Investments Climbs After PPO Medicare Advantage Plans Rated Five Stars](https://www.marketwatch.com/story/clover-health-investments-climbs-after-ppo-medicare-advantage-plans-rated-five-stars-00b8be34?ref=bullished.co) — MarketWatch
- [Clover Health Medicare Advantage PPO Plans Earn 5 Star](https://www.globenewswire.com/news-release/2026/10/08/3377770/0/en/clover-health-medicare-advantage-ppo-plans-earn-5-star-rating-for-2027.html?ref=bullished.co) — globenewswire.com