Centene, one of the largest Medicare Advantage insurers, has sued the federal government over the star ratings its plans received for 2027, joining a growing list of insurers taking the Centers for Medicare & Medicaid Services to court over the quality scores that seniors see when they shop for coverage.
The lawsuit, filed Thursday, Oct. 23, in federal court in the Southern District of Georgia, argues that CMS violated the Administrative Procedure Act in how it used 17 measures to calculate Centene’s scores, Fierce Healthcare reported. Modern Healthcare described it as the third legal challenge so far to the 2027 ratings.
The fight lands in the middle of Medicare open enrollment, which runs through Dec. 7. Star ratings are one of the main tools seniors and brokers use to compare plans, and they also decide which insurers get federal bonus payments.
What is Centene claiming in its lawsuit?
Centene says the challenged measures were adopted in violation of “core statutory safeguards” and that they dragged down its results. For 2027, 9% of Centene’s members are in plans rated four stars or higher, down from 18% the year before, according to the complaint as reported by Fierce Healthcare.
The company estimates that if the 17 measures had been left out, it would receive $448 million more in quality bonus payments for the 2028 plan year. Centene said in the complaint that the lower scores cost it “hundreds of millions of dollars in revenue that Centene could use to strengthen benefits, reduce premiums, and improve health outcomes,” and that “depressed ratings also inflict significant reputational damage and diminished membership.”
Centene had not responded to a request for comment when Fierce Healthcare published its report.
Why are insurers suing over star ratings?
The wave of lawsuits traces back to a ruling earlier this year in a case brought by Clover Health. In May, a federal judge in the Southern District of Georgia set aside Clover’s 2026 star rating, finding that 20 measures CMS used were unlawful, and ordered the agency to recalculate it. CMS then recalculated scores across the industry but threw out only 10 of the measures, those the court found to be beyond the agency’s authority, and the administration has appealed the decision.
Alignment Healthcare sued earlier this month in Washington, D.C., arguing that CMS spelled out key measures in “technical notes” instead of going through formal rulemaking. Just 25% of Alignment’s members are in plans with four or more stars for 2027, down from 100% in 2026, according to Fierce Healthcare.
The stakes are large. Plans rated four stars or higher qualify for bonus payments from Medicare, money insurers often use to fund extra benefits such as dental coverage, lower premiums or smaller copays.
How did Medicare Advantage plans score for 2027?
Overall, ratings held fairly steady. According to CMS’s 2027 star ratings fact sheet, about 37% of Medicare Advantage plans with drug coverage, or 188 contracts, earned four stars or more. Because many of the highest-rated plans are large, about 71% of enrollees are in contracts that will have four or more stars in 2027. The enrollment-weighted average rating slipped to 3.99 from 4.01.
Only 15 Medicare Advantage contracts earned the top five-star rating for 2027. Stand-alone Part D drug plans improved: about 22% of their enrollees are in plans with four or more stars, up from 2% in 2026.
What should seniors do during open enrollment?
A lawsuit will not change the star ratings seniors see on the Medicare Plan Finder this fall, and court cases like these can take months. For now, the ratings shown are the official 2027 scores.
Stars are only one factor in choosing a plan. Before Dec. 7, seniors should also check:
- Whether their doctors, hospitals and pharmacies are in the plan’s network for 2027.
- Total costs, including premiums, deductibles, copays and the plan’s out-of-pocket maximum.
- How the plan covers the prescriptions they take, using the drug list on Plan Finder.
- Prior authorization rules and coverage for services they use often, such as therapy or home medical equipment and mobility aids.
Medicare also allows people to switch into a plan rated five stars once during the year, outside of open enrollment, through a special enrollment period. Free, unbiased help is available from State Health Insurance Assistance Programs and 1-800-MEDICARE.
Seniors whose plans are leaving the market entirely have additional options. HNC has covered what to do if your Humana or UnitedHealthcare Medicare Advantage plan is ending.
Key Takeaways
- Centene sued CMS on Oct. 23 over its 2027 Medicare Advantage star ratings, challenging 17 measures in federal court in Georgia.
- Centene says 9% of its members are in plans with four or more stars for 2027, down from 18%, and estimates the measures cost it $448 million in 2028 bonus payments.
- It is at least the third legal challenge to the 2027 ratings, following a Clover Health ruling that struck down 20 measures used in 2026.
- Nationally, about 71% of Medicare Advantage enrollees are in plans with four or more stars for 2027, according to CMS.
- The ratings on Medicare Plan Finder remain the official scores during open enrollment, which ends Dec. 7.
Frequently Asked Questions
What are Medicare Advantage star ratings?
They are CMS’s 1-to-5-star quality scores for Medicare Advantage and Part D plans, based on measures such as preventive care, chronic disease management, member experience and customer service. They appear on the Medicare Plan Finder.
Why did Centene sue CMS?
Centene says CMS unlawfully used 17 measures to calculate its 2027 ratings, lowering its scores and costing it an estimated $448 million in quality bonus payments for 2028.
Will the lawsuit change my plan’s star rating this year?
Not during this open enrollment period. The ratings shown on Medicare Plan Finder are the official 2027 scores, and the court case is just beginning.
When does Medicare open enrollment end?
Medicare open enrollment runs from Oct. 15 to Dec. 7. Changes take effect Jan. 1.
