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CVS Health is suing the federal government to block a $2 billion revenue hit tied to its falling 2027 Medicare Advantage star ratings. It's the fifth insurer — joining Alignment Healthcare, Healthfirst, SCAN Health Plan, and Centene — to challenge CMS' methodology in court, arguing the agency used illegally adopted measures to calculate scores. The lawsuits could force a sweeping recalculation of next year's quality ratings.
A wave of insurers is taking the federal government to court over 2027 Medicare Advantage (MA) star ratings, and CVS Health is the latest — and most aggressive — to join the fight. CVS filed a complaint in Georgia district court arguing that CMS used illegally adopted measures to calculate quality scores, causing the share of its members in four-star-or-above plans to drop from 84% to 67%. The insurer is asking the court to vacate ratings for dozens of its contracts and force a recalculation without the 28 disputed measures it's challenging — the most of any insurer so far.
The legal strategy mirrors that of at least four other insurers — Alignment Healthcare, Healthfirst, SCAN Health Plan, and Centene — all of whom argue CMS violated the Administrative Procedure Act by using measures that were never subject to proper notice-and-comment rulemaking. The argument has precedent: a Georgia court ruled in favor of insurer Clover Health this past spring, tossing 20 such measures from 2026 calculations. CMS applied only a partial fix for 2027, leaving the door wide open for litigation.
By the Numbers:
Why it matters: Star ratings aren't just a report card — they determine billions in bonus payments and shape seniors' plan choices. With multiple major insurers now in court and CMS' methodology under fire, the outcome could reshape how MA quality is measured and rewarded across the entire program.
