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Carriers & the market

CMS Brings Its Medicare Advantage Star Ratings Defense to a Federal Appeals Court

Federal health officials filed an appeal July 21 in the Eleventh Circuit, seeking to restore their original methodology for calculating 2026 Medicare Advantage quality scores after a lower court ruled in favor of insurer Clover Health.

By the Goodsurance editorial teamJuly 21, 2026

The Centers for Medicare and Medicaid Services moved its dispute over 2026 Medicare Advantage star ratings to the U.S. Court of Appeals for the Eleventh Circuit on July 21, 2026, according to a court filing. The appeal challenges a May ruling by U.S. District Judge Lisa Godbey Wood, who found that CMS had improperly included 20 quality measures in the 2026 star ratings calculation. That ruling required CMS to recalculate the rating for Clover Health's largest Medicare Advantage contract, lifting it from 3.5 stars to 4.5 stars. Star ratings in Medicare Advantage shape which plans earn quality bonus payments from the federal government and how attractive those plans appear to prospective enrollees. Following the Clover decision, CMS voluntarily recalculated ratings for other affected contracts as well, boosting scores for dozens of plans. That broader recalculation then drew further legal action from insurers who said they were treated inconsistently. SCAN Health Plan filed a complaint in early July, Alignment Healthcare followed with a nearly identical suit, and Elevance Health separately sued CMS over five contracts it argued had not received the same corrective treatment. By appealing to the Eleventh Circuit, CMS is asking a higher court to review whether the lower court was correct that the 20 disputed measures should have been excluded. The outcome could affect quality bonus payments tied to 2026 ratings and could shape how star ratings are calculated in future plan years.

CMS appealed the Medicare Advantage star ratings ruling on July 21. The case could reset how quality bonuses are calculated for years to come.

In plain words

Medicare Advantage plans get a quality score from 1 to 5 stars. Higher scores mean bonus money from the government. A court said CMS used 20 wrong measures to set the 2026 scores. One insurer's rating went up from 3.5 to 4.5 stars after the ruling. CMS fixed scores for many other plans too. Several insurers then sued, saying CMS treated them unfairly. On July 21, CMS filed its own appeal asking a higher court to review the original ruling.

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Source: Healthcare Dive
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