UPDATED: Nov. 9 at 2:30 p.m. ET
Elevance Health is the latest insurer to sue the feds over its performance in the latest round of star ratings for the Medicare Advantage program.
The company sued the Centers for Medicare & Medicaid Services in District of Columbia federal court on Friday, arguing that the 2027 star ratings calculations violated the Administrative Procedure Act in using 11 measures that it says were adopted unlawfully.
In the lawsuit, the company said that the harm from including these measures is "concrete and substantial." If they were excluded, it would increase the scores for 12 of its Medicare Advantage contracts and generate $516 million in additional quality bonus payments.
"Their inclusion therefore does more than violate statutory requirements in the abstract: it depresses Elevance Health’s ratings and reduces the funding available for the following payment year," per the lawsuit. "That funding could support broader supplemental benefits, lower premiums and cost-sharing, and improved care coordination."
"CMS’s unlawful methodology puts those resources out of reach," the company said.
In addition to the financial impacts, Elevance argues that the star ratings scores can also lead to reputational damage that makes it harder for them to compete in the MA market. It also provides prospective enrollees with inaccurate information, the company said.
"Beneficiaries cannot make informed coverage choices when the government’s own comparison tool conveys a distorted assessment of the plans available to them," Elevance said.
"An artificially depressed rating does not merely place Elevance Health at a competitive disadvantage; it undermines the very comparison the program is supposed to enable," the company continued. "A rating lowered by unlawful measures presents beneficiaries with a misleading signal of relative quality, rather than a lawful basis for distinguishing among competing plans."
UPDATED: Oct. 27 at 2:45 p.m. ET
CVS Heath's Aetna is joining the ranks of insurers suing over its results in the 2027 Medicare Advantage star ratings.
The insured filed suit Monday in Georgia's Southern District Court, and argues that 28 measures used by the Centers for Medicare & Medicaid Services to calculate its scores were "unlawfully adopted" and should have been excluded.
The court is the same venue that ruled in favor of Clover Health over the summer, and set aside 20 measures that were used to determine its 2026 scores. That decision, which the feds have appealed, kicked off a broad recalculation of 2026 scores that looked different for insurers outside of Clover, triggering a wave of litigation.
In its lawsuit, Aetna cites the Clover decision in finding that CMS extended beyond its statutory authority in deploying those 20 measures.
The company said that calculating its scores using the 28 measures in question will likely cost it $2 billion in 2028 quality bonus payments and rebate retention. Those are funds that the insurer could "apply toward expanding member benefits, reducing premiums and investing in quality improvement."
Aetna adds that in addition to the monetary loss, having lower scores negatively impacts the company's reputation and its ability to attract potential members.
"The harm to CVS Health is not exclusively financial; lower ratings carry meaningful reputational harm, which can in turn impact membership," per the lawsuit. "By incorporating unlawful measures into the 2027 Star Ratings calculation, CMS cast CVS Health’s ratings in a poorer light in the eyes of Medicare Advantage consumers relative to peer MAOs, undermining CVS Health’s ability to compete for Medicare beneficiaries through enhanced benefits and the like."
Aetna did not respond to a request for comment at the time of publication.
Based on an analysis from Stephens, 69% of Aetna's MA members are in plans with four or more stars for 2027, down from 81%. That threshold is the key to securing quality bonus payments.
Aetna's complaint follows others focused on the 2027 scores from Centene and Alignment Healthcare (see those stories below).
UPDATED: Oct. 23 at 3 p.m. ET
Centene sues over MA star ratings
Centene has become the latest insurer to sue the federal government over its 2027 Medicare Advantage star ratings.
In a lawsuit filed Thursday in Georgia's Southern District Court, the company argues that the Centers for Medicare & Medicaid Services violated the Administrative Procedure Act in determining its latest scores. Centene says that CMS ran afoul of "core statutory safeguards" in deploying 17 measures.
The use of those measures ultimately caused "significant injury" to the company, according to the complaint. For 2027, 9% of Centene's members are enrolled in plans with at least four stars, which declined from 18% in the prior year.
"In implementing each of the individual Star measures that Centene challenges, CMS violated applicable law and thereby caused Centene to lose out on hundreds of millions of dollars in revenue that Centene could use to strengthen benefits, reduce premiums, and improve health outcomes," the company said in the lawsuit.
CMS argues that the court has already sided with a similar argument in its decision in favor of Clover Health earlier this year. In that case, which led to a broad recalculation in scores, the courts set aside 20 measures that were used in determining Clover's star ratings for 2026.
If the 17 measures in question had been excluded in calculating Centene's scores, the company estimates it would receive $448 million more in quality bonus payments for the 2028 plan year, funds it would deploy to expand benefits, lower premiums and enhance programs like care coordination.
In addition to the financial impact, a drop in star ratings also carries a reputational hit, Centene said.
"Beyond the financial impact to the company and its members, depressed ratings also inflict significant reputational damage and diminished membership," the company said in the complaint
Centene had not returned a request for comment at the time of publication.
PUBLISHED: Oct. 12 at 3 p.m. ET
Alignment Healthcare sues to challenge MA star ratings
Alignment Healthcare sued federal regulators, alleging that its 2027 Medicare Advantage star ratings were determined "in flagrant violation" of statute.
In the lawsuit filed Friday in District of Columbia federal court, the insurer says that the Centers for Medicare & Medicaid Services "has completely departed from Congress’s vision of leveraging predictable, valid measures developed with input from providers, plans, and the public" in establishing the methodology for the star ratings.
The company argues that rather than establish "consistent, stable specifications" for metrics through the traditional rule-making process, the agency instead detailed key measures through a series of "technical notes." This violates the Administrative Procedure Act, per the lawsuit.
The program's star ratings are the critical determinant in quality bonus payments to insurers as well as a tool that aims to make it easier for enrollees and brokers to identify benefits with the highest quality.
"Consistent application of the statutory requirements governing Star Ratings is therefore essential not only to plan payments and competition but also to ensuring that beneficiaries can rely on the Star Ratings as meaningful and comparable measures of plan quality," Alignment said in the lawsuit.
The company adds that multiple recent court decisions have set aside CMS' star ratings methodology, notably a ruling over the summer in favor of Clover Health that tossed 20 metrics used in the 2026 calculations. A Georgia federal judge determined that 10 measures utilized exceeded CMS' authority, while 10 other measures were promulgated inappropriately.
CMS recalculated the scores across the board following the ruling, but only set aside the 10 measures that the courts determined were outside the bounds of its regulatory authority. The agency maintained that approach in the 2027 calculations, Alignment argues.
"Congress created the Star Ratings program to allow Medicare Advantage beneficiaries to make informed decisions about plan enrollment based on clinically validated measures of plan quality that had been subjected to notice and comment," the company said. "CMS’s contrary approach fails to carry out the vision that Congress set forth by statute."
The Trump administration has appealed the Clover decision, so that legal case remains ongoing.
In addition, Alignment argues it suffered reputational and financial damage as a result of its 2027 scores, which plummeted compared to the prior year. Just 25% of its members are in plans with four or more stars for 2027, down from 100% in 2026.
Shares in the company tumbled following the release of the ratings, though stock prices have rebounded since.
Alignment sued the feds following the Clover decision to secure a recalculation for its scores that aligns with the court's decision, and in a statement to Fierce Healthcare, said that the lawsuit aligns with that perspective.
"Our lawsuit seeks to ensure that the Star Ratings program operates as Congress intended and that Alignment is properly compensated for the care we provide," Alignment said in the statement. "We respect the judicial process and will present our case in court. Because this matter involves pending litigation, we will not comment on the specific legal arguments beyond our filings."
"Our focus remains on delivering exceptional care, improving health outcomes and advocating for a stable, lawful regulatory framework that supports seniors and strengthens the Medicare Advantage program," the company said.