CVS sues CMS to overturn 2027 Medicare Advantage star ratings it says would cost about $2bn

In context: this report covers a source published on 28 Oct 2026.

CVS Health filed its complaint on 26 October in federal district court in Georgia, arguing that the Centers for Medicare & Medicaid Services (CMS) based its 2027 Medicare Advantage star ratings on measures it had not properly adopted, Healthcare Dive reported. CVS asks the court to set aside the ratings for dozens of its contracts and order CMS to recalculate them without 28 disputed measures.

The amounts are large for the insurer's Medicare business. According to the complaint, 43 CVS contracts would have scored at least half a star higher without those measures. The share of its members in plans rated four stars or more fell from 84% for 2026 to 67% for 2027. CVS has 4.2 million Medicare Advantage members and estimates it would lose about $2bn of bonus payments in 2028, the year payments reflect the 2027 scores. Healthcare Dive noted that the sum is small against almost $135bn of CVS premium in 2025, but larger than the $1.8bn operating income of Aetna's health benefits division that year.

CVS is at least the fifth insurer to sue over the 2027 ratings, after Alignment Healthcare, SCAN Health Plan, Healthfirst and Centene. The cases build on a ruling earlier this year in the same Georgia court, which found for Clover Health that 20 measures used for 2026 scores were unlawful. CMS then used half of the contested measures again for 2027 for every insurer except Clover. CVS's complaint says it "does not ask the Court to break new ground".

All the suits argue that CMS went beyond its authority by using the measures without notice-and-comment rulemaking. Healthcare Dive did not report a court timetable or a CMS response. KFF estimates that CMS paid at least $12.7bn in Medicare Advantage quality bonuses last year.