Clover Health PPO Medicare Advantage Plans Achieve 4-Star Rating for 2025

Clover Health Investments, Corp. (Nasdaq: CLOV) has announced that the Centers for Medicare and Medicaid Services (CMS) has upgraded the Star rating of its PPO Medicare Advantage plans to 4 Stars for 2025, which will impact payment year 2026. Additionally, CMS has raised the rating of Clover’s HMO Medicare Advantage plan to 3.5 Stars. Notably, over 95% of Clover’s Medicare Advantage membership is enrolled in its PPO plans.

Each year, CMS evaluates every plan based on healthcare quality and drug services, providing a Star rating ranging from 1 to 5 Stars. For this assessment year, Clover’s overall Star rating reflects its outstanding performance in various categories including Medication Adherence, the Healthcare Effectiveness Data and Information Set (HEDIS), and the Consumer Assessment of Healthcare Providers and Systems (CAHPS). Of significance, Clover achieved an impressive score of 4.94 out of 5 Stars on HEDIS, which evaluates a plan’s efficacy in delivering preventative screenings and managing a spectrum of health issues like diabetes, cancer, and heart disease.

Andrew Toy, CEO of Clover Health, stated, “At Clover Health, our mission is focused on enhancing healthcare outcomes for our members, and our 4-Star CMS rating underscores our dedication to this mission. Our commitment to quality surpasses industry benchmarks, as highlighted by our exceptional HEDIS score. By harnessing Clover Assistant technology, we provide physicians with real-time insights, enabling improved care quality through enhanced preventive services and care coordination. We will continue to prioritize these initiatives to foster meaningful, long-term health improvements for our members.”

Jamie Reynoso, CEO of Medicare Advantage at Clover Health, commented, “Our achievements reflected in this year’s Star ratings are the result of foundational enhancements we’ve made over the past several years. With a higher Star rating, we are positioned to reinvest in more competitive benefits, which we believe will provide greater value to our members while supporting ongoing membership growth. This milestone allows us to extend our impact to more individuals on Medicare without jeopardizing our financial stability or commitment to quality care.”

Clover Health operates as a Preferred Provider Organization (PPO) and a Health Maintenance Organization (HMO) under a Medicare contract, with enrollment dependent on contract renewal.

Disclaimer: The statements in this document represent the authors’ views and do not necessarily reflect the policies or opinions of CMS. The authors are responsible for the accuracy and completeness of the information presented.