Goodsurance

Carriers & the market

Elevance Health Sued CMS Over Medicare Advantage Star Ratings, Saying the Agency Fixed One Plan's Scores but Not Others

The parent company of Anthem and several Blue Cross affiliates filed suit July 1, arguing that CMS must apply the same star ratings correction to its five contracts that a court ordered for Clover Health.

By the Goodsurance editorial teamJuly 19, 2026

Elevance Health sued the Department of Health and Human Services and CMS on July 1, 2026, arguing that the agency applied an unlawful double standard when correcting 2026 Medicare Advantage star ratings.

The case follows a May 2026 ruling by U.S. District Judge Lisa Godbey Wood, who found that CMS had used 20 measures in setting Clover Health's 2026 star rating that were either unauthorized by statute or not adopted through required notice-and-comment rulemaking. CMS recalculated Clover's rating from 3.5 to 4.5 stars in response, but retained 10 of the 20 contested measures for all other plans.

Elevance says CMS fixed Clover's star ratings but skipped everyone else. Federal courts may now have to weigh in.

Elevance argues that this inconsistency is unlawful and that its five contracts, operated by Anthem Insurance Companies, Blue Cross of California, Wellpoint Health Plans, Wellpoint Insurance Company, and Wellpoint Iowa, are entitled to recalculation using the same full 20-measure exclusion applied to Clover. The suit was filed in the U.S. District Court for the Southern District of Georgia.

SCAN Health Plan filed a similar suit July 7 in Washington, D.C., and Alignment Healthcare followed July 10. Federal courts are now being asked to decide whether a partial remedy issued for one plan must be applied across the market.

Star ratings tie directly to quality bonus payments that plans use to reduce premiums and add supplemental benefits, so the outcome of this litigation could affect what Medicare Advantage enrollees are offered in future plan years.

In plain words

A large insurer called Elevance Health went to court on July 1, 2026. Elevance says the government corrected the star rating for one Medicare Advantage plan but did not do the same for others. Star ratings matter because plans with better scores get extra money from Medicare. Plans use that money to lower costs or add benefits for members. Elevance says the government must treat all plans the same way. Two other companies filed similar lawsuits later in July.

Understand the basics first

Source: Healthcare Dive
Read at the source →

More news

Other stories on what is moving in Medicare.

Carriers & the market

UnitedHealthcare and NewYork-Presbyterian Medicare Advantage Contract Expires September 30 With No Deal Announced

The extension keeping NewYork-Presbyterian in-network for most UnitedHealthcare Medicare Advantage members runs out in one week. If no agreement is reached, NYP hospitals and physician groups become out-of-network on October 1, three weeks before open enrollment starts.

September 23, 2026

Carriers & the market

CMS Closed Its Medicare Advantage Billing Enforcement Case Against Elevance After the Insurer Paid Approximately 342 Million Dollars

The case began in February with a threat to halt new enrollments over unsupported diagnosis codes. CMS declared the enforcement process finished in July after Elevance completed all required corrective steps.

September 22, 2026

Carriers & the market

Molina Healthcare Is Exiting Traditional Medicare Advantage for 2027, and Non-Renewal Notices Are Due to About 117,000 Members

Molina announced earlier this year that its standard Medicare Advantage-prescription drug product did not fit its strategy, and affected members are now in the window when they should expect to receive non-renewal notices before the October 15 open enrollment start.

September 19, 2026

Carriers & the market

HCSC Will Exit More Than 100 Medicare Advantage Counties for 2027, Redirecting Focus to Managed Care Plan Types

Health Care Service Corporation, which expanded its Healthspring-branded Medicare Advantage presence nationwide after acquiring Cigna's Medicare business in 2025, is now scaling back that footprint for 2027, exiting more than 100 counties while concentrating on HMOs and special needs plans.

September 19, 2026

Carriers & the market

Ohio State Wexner Medical Center and James Cancer Center Leave Individual Humana Medicare Advantage Network October 1

Humana's individual Medicare Advantage contract with Ohio State University facilities expires without renewal on October 1. Group Medicare and Medicaid coverage through Humana is not affected.

September 17, 2026

Carriers & the market

Federal Audit Estimates UnitedHealthcare of Wisconsin Owes at Least 46.9 Million Dollars in Medicare Advantage Overpayments

Auditors found medical records did not support diagnosis codes in 183 of 250 sampled enrollee-years that the plan submitted to determine its CMS payments.

September 16, 2026