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

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 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.