The star ratings battle continues, this time with Elevance Health.
Elevance filed a lawsuit last week against the Department of Health and Human Services and the Centers for Medicare & Medicaid Services, alleging that CMS unlawfully refused to recalculate Elevance’s 2026 Medicare Advantage Star Ratings on the same basis that it recently recalculated Clover Health’s ratings after a court ruling.
In Clover Health’s case, a federal judge ruled that CMS improperly used 20 quality measures when calculating Clover Health’s 2026 Medicare Advantage Star Rating because the agency relied on data sources not authorized by law and failed to follow the required public rulemaking process. This includes measures on medication adherence and call center data. The judge ordered CMS to recalculate Clover’s rating excluding those 20 measures, bumping Clover from 3.5 stars to 4.5 stars.
Star ratings are important as CMS provides higher bonus payments to plans with higher ratings. These payments can be used to increase member benefits, reduce premiums and more. Elevance alleged that if CMS applied the same recalculation methodology to Elevance that it used for Clover, Elevance would have received a $115 million increase in Quality Bonus Payments. The insurer said that there are five contracts at issue that would receive higher ratings of 3.5-4.5 stars versus 3-4 stars.
The harm “extends beyond the financial,” Elevance alleged in the complaint.
“CMS publicizes Star Ratings through its My Plan Finder tool, directly affecting beneficiary enrollment decisions; contracts rated 4.0 Stars or above can offer enhanced benefits funded by higher QBPs, which in turn determines competitive positioning in the MA marketplace,” Elevance argued. “By giving Clover a recalculated, more favorable Star Rating while refusing to extend that same recalculation to Elevance, CMS has directly disadvantaged Elevance in markets where the two MAOs compete for the same Medicare beneficiaries.”
Elevance added that there is no legal basis for the differential treatment between Clover and Elevance.
“If those measures were legally defective as applied to Clover—as the court held—they were equally defective as applied to Elevance,” the complaint stated. “CMS cannot rationally maintain that the same methodology is simultaneously legally defective (for Clover, necessitating recalculation) and legally sound (for all other MAOs, justifying no recalculation), absent some specific factual distinction between Clover and those other MAOs. No material distinction exists.”
The insurer argued that CMS’ actions relating to the 2026 star ratings are reviewable under the Administrative Procedure Act and are arbitrary and capricious. Elevance stated that before filing the lawsuit, the company made a written request to CMS to update its star ratings using the same recalculation it made for Clover, but CMS rejected that request, Elevance alleged.
“By this lawsuit, Elevance seeks an order compelling CMS to give Elevance the identical relief it has already given to Clover: a recalculation of its 2026 Star Ratings by excluding the same twenty measures that the Clover court held were legally or procedurally unlawful,” the insurer said.
This isn’t the first time Elevance has challenged its star ratings. The insurer also challenged its 2024 ratings, securing a partial victory, and its 2025 ratings, though that challenge was unsuccessful.
Photo: Warchi, Getty Images
