Clover Health Comments on 2026 Medicare Advantage Star Ratings and Trajectory for Increasing Profitability into 2027

Core Viewpoint - Clover Health Investments, Corp. emphasizes its differentiated business model and expresses confidence in achieving above-market membership growth and increasing Adjusted EBITDA profitability through 2027, independent of Star ratings [1][2]. Business Performance - Clover Health's Medicare Advantage plans received a 3.5 Star rating for its PPO plans and a 4.0 Star rating for its HMO plan from CMS for the 2026 payment year, which will affect payments in 2027 [1]. - In the first half of 2025, Clover Health experienced a 34% increase in revenue and a 32% increase in membership year-over-year, while maintaining sustained Adjusted EBITDA profitability [2]. Clinical Quality - Clover Health scored 4.72 on HEDIS clinical quality measures for its PPO plans, indicating strong performance in clinical measures, largely attributed to its Clover Assistant clinical platform [3]. Health Policy Perspective - The company argues that the Star rating system does not accurately reflect the health outcomes it delivers, as it places excessive weight on non-outcome measures rather than actual clinical results [4]. - Clover Health is actively engaging with CMS to ensure that its Star rating accurately reflects the quality of its Medicare Advantage offerings [4]. Future Outlook - The company anticipates continued strong above-market growth in Medicare Advantage and expansion of Adjusted EBITDA profitability during 2026 and 2027, driven by several strategic initiatives [6]. - Key drivers include the development of AI-powered features in Clover Assistant, increasing physician adoption, prioritizing member retention, and optimizing operating leverage [7].