Carriers & the market
Medicare Advantage Star Ratings Litigation Widens to at Least 10 Insurers as Open Enrollment Continues
Jefferson Health Plans, a university-affiliated plan in Pennsylvania, became among the latest to challenge CMS's 2027 rating methodology in court, joining a legal pileup that now spans plans of every size and type.
By the Goodsurance editorial teamNovember 10, 2026
A Philadelphia-area health plan affiliated with Thomas Jefferson University filed a federal lawsuit against CMS on November 9, challenging the star ratings assigned to three of its Medicare Advantage plans for 2027. The filing brought the total number of insurers suing over their 2027 quality scores to at least 10.
The plan said ratings for two of its contracts fell from 3.5 to 3 stars, and a third dropped from 3 to 2.5. Jefferson described itself as a community-focused health plan and said the lower ratings would substantially reduce the federal quality bonus payments it would otherwise receive in 2028, putting it at a competitive disadvantage against larger national carriers.
At least 10 Medicare Advantage plans have now sued CMS over their 2027 star ratings. Those same disputed scores are what shoppers see on Medicare Plan Finder today.
All of the suits share a legal foundation: a Georgia federal court ruling from earlier in 2026 that found CMS had improperly included certain medication adherence measures in its quality calculations without completing the required notice-and-comment rulemaking. That decision came in a case brought by Clover Health. CMS is appealing the ruling.
The litigation now spans multiple federal courts and covers a wide range of insurer types, from large national carriers to nonprofit community plans. The wave began with smaller plans contesting 2026 scores and shifted to 2027 scores after CMS published those ratings in October.
For people shopping during open enrollment, which runs through December 7, the star ratings displayed on Medicare Plan Finder are the same contested scores at the center of the lawsuits. Plans that earn four stars or higher receive enhanced bonus payments from Medicare, money they can use to offer lower premiums or additional supplemental benefits to their members. CMS has not indicated any plans to pause or recalculate 2027 scores while the appeals proceed.
In plain words
A health plan tied to Thomas Jefferson University in Philadelphia sued the federal government on November 9 over its Medicare quality scores for 2027. The plan says its scores fell unfairly because the government used rating rules that a court found improper earlier this year. At least nine other insurance companies had already sued over the same thing. All the lawsuits say CMS used scoring methods it was not allowed to use.
These quality scores matter because plans with high scores get extra money from Medicare. They use that money to offer members lower premiums and extra benefits. Plans say the improper rules pushed them below the cutoff for that extra money.
The scores being challenged right now are the same ones shown on the Medicare website while open enrollment is running. Open enrollment runs through December 7.
Understand the basics first
Source: Philadelphia Inquirer
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