Carriers & the market
CVS Health Becomes Fifth Insurer to Sue CMS Over 2027 Medicare Advantage Star Ratings
CVS Health filed a federal lawsuit Monday challenging the methodology behind its 2027 Medicare Advantage star ratings, joining at least four other insurers in court after CMS released quality scores on October 8.
By the Goodsurance editorial teamOctober 29, 2026
CVS Health filed a complaint in U.S. District Court for the Southern District of Georgia on October 27, 2026, alleging that the Centers for Medicare and Medicaid Services violated the Administrative Procedure Act when it calculated 2027 Medicare Advantage star ratings. The lawsuit names both the Department of Health and Human Services and CMS as defendants.
The share of CVS members enrolled in Aetna Medicare plans rated four stars or higher dropped from 84 percent in 2026 to 67 percent in 2027. CVS said in its complaint that the decline will cost it substantially in quality bonus payments in 2028, the year in which payments are adjusted based on 2027 scores. The lawsuit asks a court to vacate star ratings for dozens of CVS contracts and require CMS to recalculate scores using only measures that were properly adopted.
CVS Health is the fifth insurer to sue CMS over 2027 Medicare Advantage star ratings, challenging the legality of quality scores used by consumers to compare plans during open enrollment.
The legal challenge argues that CMS relied on quality measures that were adopted without the notice-and-comment rulemaking required by law. The lawsuit cites a federal court ruling from earlier in 2026 in a case brought by insurer Clover Health, which found that 20 measures used in 2026 star scores were illegally adopted. CMS applied 10 of those same measures to other insurers when calculating 2027 ratings.
CVS is now the fifth company to challenge its 2027 star ratings in court, following Alignment Healthcare, Healthfirst, SCAN Health Plan, and Centene. Star ratings are released each fall and are used by Medicare beneficiaries during open enrollment to compare plans on quality. Plans rated four stars or above receive federal bonus payments that plans can use to offer lower premiums and added benefits. The growing wave of litigation arrives while open enrollment runs through December 7.
In plain words
CVS Health is a large company that runs Medicare Advantage plans under the Aetna name. On October 27, CVS went to court to fight its 2027 Medicare plan grades, which are called star ratings. CVS says its grades dropped sharply this year. Lower grades mean the company gets less money in government bonuses in 2028. CVS argues the government did not follow the right steps when it set the grades. A court already found earlier this year that some grading tools were set up incorrectly, in a case by another insurance company called Clover Health. CVS is now the fifth insurance company to sue the government over the same grading issue this year. The other four are Alignment Healthcare, Healthfirst, SCAN Health Plan, and Centene. The grades matter to Medicare members because higher-rated plans often have lower costs and more benefits. People shopping for Medicare plans can see star ratings on the Medicare Plan Finder website. Open enrollment runs through December 7.
Understand the basics first
Source: Healthcare Dive
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