At least five health insurers have now sued CMS over their 2027 Medicare Advantage star ratings, claiming the agency used quality measures that were never formally adopted through the rulemaking process. Combined, the plans say the ratings will cost them more than $3 billion.
Over the last several years, CMS has faced an onslaught of litigation from the industry over how it calculates the ratings, which can lead to millions of dollars in bonus payments for high-rated contracts. In 2024, wins by SCAN and Elevance Health led the agency to recalculate ratings for every MA contract, while challenges to the 2025 ratings produced mixed results for the industry.
In May, a federal judge in Georgia ruled that CMS improperly included 20 measures in Clover Health’s 2026 rating, finding the agency lacked authority for 10 of them and skipped notice-and-comment rulemaking for the other 10. CMS raised Clover’s PPO contract from 3.5 to 4.5 stars and recalculated other plans’ ratings, but only where scores would improve and using a different set of measures. CMS’2027 MA rule removes 11 measures the agency described as administrative or lacking meaningful variation, mostly starting with the 2029 ratings.
Here are the five lawsuits filed so far over the 2027 ratings: ARTICLE