Jefferson Health Plans Sues CMS Over Star Ratings
The Thomas Jefferson University insurer says a 2027 star ratings drop would cut its 2028 quality bonuses by $43 million.
Updated on Nov. 9, 2026 in Healthcare
Live Poll
Do you trust federal Medicare star ratings to fairly compare health insurance plans?
Jefferson Health Plans, the insurance arm of Thomas Jefferson University, sued the Centers for Medicare and Medicaid Services over a drop in its 2027 Medicare Advantage star ratings. At least nine other Medicare Advantage insurers have also sued CMS over the 2027 ratings.
Why it matters
Star ratings determine quality bonus payments to Medicare Advantage insurers, so lower ratings directly affect the money plans receive. Jefferson's case relies on a federal court ruling in Georgia that found CMS used improper measures in calculating another insurer's ratings.
Jefferson's three plans dropped a combined half-star or more, which reduces its 2028 quality bonus payments by $43 million, while CVS Health says a similar decline would cost it more than $2 billion in 2028. Whether the courts will restore the prior ratings has not been determined.
The players
Jefferson Health Plans
The insurance arm of Thomas Jefferson University, serving Medicare Advantage members in eastern Pennsylvania and South Jersey.
Centers for Medicare and Medicaid Services
The federal agency that administers Medicare and Medicaid and calculates the star ratings used to set Medicare Advantage quality bonuses.
CVS Health
A major health services company whose insurance operations are also suing CMS, arguing the 2027 ratings decline would cost it more than $2 billion in 2028.
Clover Health
A Medicare Advantage insurer whose 2025 star ratings were found to have been calculated using improper measures in a federal court ruling in Georgia.
The details
Jefferson filed its lawsuit in U.S. District Court for the District of Columbia, challenging three medication adherence measures that a federal court in Georgia found unlawful in calculating Clover Health's 2025 star ratings. Jefferson argues some measures relied on data not authorized by law, and others required a more rigorous adoption process. Insurers began suing CMS on October 9, the day after the agency released the 2027 ratings.
Timeline
2025: CMS calculated Clover Health's star ratings using measures later found improper.
October 9, 2026: Insurers began suing CMS, the day after the 2027 ratings were released.
Last Wednesday: Jefferson filed its lawsuit in D.C. federal court.
2028: Reduced quality bonus payments tied to the lower ratings are scheduled to take effect.
Market Landscape
The dispute over the Medicare Advantage star ratings system follows a federal court ruling in Georgia that CMS used 20 improper measures for Clover Health's 2025 ratings. With at least ten insurers now litigating the 2027 ratings, the outcome could reshape how quality bonuses are distributed across the Medicare Advantage market.
Medicare Advantage members enrolled in plans whose star ratings fall may see changes in the benefits and bonus-funded perks their insurers can afford. The lawsuits could eventually alter which plans members choose during open enrollment.
The takeaway
Medicare Advantage shoppers should check the star ratings of their current plan before the next enrollment period. Ratings can change year to year, and a drop can affect the benefits an insurer is able to offer.
Further reading
For broader context on how federal health insurance policy is set, explore the Healthcare section.
Source note: This article includes information reported by The Philadelphia Inquirer.
Live Poll
Do you trust federal Medicare star ratings to fairly compare health insurance plans?
