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
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