Medicare Advantage
Court-Ordered Star Rating Redo Gave 47 Medicare Advantage Plans a Higher Score
After a federal court ruled CMS used flawed measures for Clover Insurance, the agency recalculated ratings across the entire Medicare Advantage market and upgraded 47 contracts, contributing to a bonus pool KFF now estimates at 13.4 billion dollars for 2026.
By the Goodsurance editorial teamJuly 20, 2026
A federal district court in Georgia ruled in 2026 that the Centers for Medicare and Medicaid Services had used 20 improper quality measures when computing Clover Insurance Company's Medicare Advantage star rating. In response, CMS issued guidance directing it to recalculate star ratings for all Medicare Advantage contracts using a corrected method. A contract would receive the recalculated score only if that score was higher than its original rating.
The outcome: 47 contracts received higher star ratings than they originally earned. Thirty-six of those contracts now carry at least four stars, qualifying them for the 5-percent quality bonus payment that CMS awards to high-rated plans.
CMS redid Medicare Advantage star ratings after losing a court case. Forty-seven plans got higher scores, growing a bonus pool that KFF now pegs at 13.4 billion dollars.
The Medicare Rights Center reported on July 23, 2026, that the recalculation added to an already growing bonus pool. KFF estimated that total quality bonus payments for Medicare Advantage in 2026 will reach at least 13.4 billion dollars, roughly four times the amount spent on the program in 2015.
The legal landscape has kept expanding. Several other Medicare Advantage insurers filed similar lawsuits after Clover's victory, seeking their own ratings corrections. CMS indicated it is reviewing how to address those cases and is considering longer-term revisions to the star-rating methodology.
For enrollees, star ratings shape what benefits a plan can afford to offer. Plans that gained stars from the recalculation have additional revenue that may flow through as lower premiums or richer coverage in future contract years.
In plain words
A court said CMS used wrong tools to rate a Medicare Advantage company called Clover. CMS then reran the ratings for every Medicare Advantage plan using the corrected method. Plans only got a new rating if it was higher than the old one. Forty-seven plans got a higher score. Thirty-six of those now have at least four stars. Having four or more stars means a plan gets a 5-percent bonus payment from CMS. KFF says the total bonus pot for all Medicare Advantage plans in 2026 is at least 13.4 billion dollars, which is four times larger than it was in 2015. Other insurers have now filed similar court cases, and CMS is deciding what to do.
Understand the basics first
Source: Medicare Rights Center
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