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Highlights
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Clover Health’s PPO Medicare Advantage plans have received a Star rating increase to 4 Stars for 2025, impacting payment year 2026.
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The HMO Medicare Advantage plan rating has also risen to 3.5 Stars, with over 95% of Clover’s Medicare Advantage membership served through PPO plans.
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The improved ratings are attributed to strong performance in Medication Adherence, HEDIS, and CAHPS measures, with HEDIS scoring 4.94 out of 5 Stars.
Overview
Clover Health {NASDAQ:CLOV} has announced an upgrade in the Star ratings for its Medicare Advantage plans, with the Centers for Medicare and Medicaid Services (CMS) increasing the rating of its Preferred Provider Organization (PPO) plans to 4 Stars for the year 2025, affecting the payment year 2026. In addition, the company’s Health Maintenance Organization (HMO) Medicare Advantage plan has improved its rating to 3.5 Stars. Notably, more than 95% of Clover’s Medicare Advantage membership is covered through its PPO plans, making this upgrade particularly significant.
The enhanced Star ratings were driven by Clover's exceptional performance in key metrics such as Medication Adherence, the Healthcare Effectiveness Data and Information Set (HEDIS), and the Consumer Assessment of Healthcare Providers and Systems (CAHPS). The company achieved an impressive score of 4.94 out of 5 Stars on the HEDIS measures, which evaluate a health plan’s ability to deliver preventive screenings and manage various health conditions effectively.
Andrew Toy, Clover's CEO, highlighted the company’s commitment to enhancing healthcare outcomes through innovative technology solutions like the Clover Assistant. This platform supports healthcare providers in making informed decisions and improving patient care. The elevated Star ratings are anticipated to enable Clover Health to enhance its benefits offerings, potentially fostering membership growth while maintaining strong financial performance and high standards of care quality.
Clover Health’s focus on leveraging technology to improve healthcare delivery and patient engagement positions the company well for continued growth in a competitive market. As the healthcare landscape evolves, the emphasis on quality measures and patient satisfaction will remain critical for insurers and providers alike.
