Centene sues CMS, says star ratings cost it $448 million

Updated Oct 28, 2026, 9:30 PM CT: adds the CVS Health and SCAN suits. At least five insurers have now sued over 2027 stars.

Centene says the government’s 2027 Medicare Advantage star ratings will cost it about $448 million in 2028 bonus payments and rebates. That figure is in a complaint Centene and 35 of its health plan companies filed Oct 22 in federal court in Brunswick, Georgia.

The defendants are the Department of Health and Human Services and the Centers for Medicare & Medicaid Services (CMS). Judge Lisa Godbey Wood has the case, per the Georgetown litigation tracker. No court has ruled on it.

What Centene is asking for

CMS published the 2027 ratings on Oct 8. Centene says 34 of its contracts scored lower than they should have because CMS counted 17 measures it never had the right to use. Some, it argues, go beyond what the Medicare law allows. Others were never put through public notice and comment.

The complaint asks the judge to:

• set aside the 2027 overall ratings on those contracts and order CMS to recalculate them without the 17 measures
• strike the low performance warnings on two contracts
• order CMS to pay 2028 bonuses and rebates on the corrected scores
• let Centene revise its 2028 bids, which are due to CMS on June 7, 2027

Centene says its company wide average would rise from 3 stars to 4. That average also sets the rating on four newer contracts.

Why a half star matters

Star ratings run from 1 to 5 and sit next to every plan on Medicare Plan Finder. Plans rated 4 stars or higher get a quality bonus from CMS. The complaint says that money can pay for extra benefits, lower premiums and care programs.

One Georgia contract, H1112, got 3.5 stars. Centene says it would have reached 4 without the disputed measures.

A plan whose Part C or Part D summary score falls below 3 stars gets a low performance warning on Plan Finder. If a plan carries that warning three rating years in a row, CMS can end its contract. Two Centene contracts have the warning now:

• H4661, run by Celtic Insurance Company, about 4,000 members in Delaware, 2.5 stars
• H6348, run by Coordinated Care Corporation, about 6,000 members in Indiana, 2.5 stars

Centene says neither would carry the warning without the 17 measures.

The case it is leaning on

The same court ruled for Clover Health on May 27, 2026, and ordered CMS to redo Clover’s 2026 ratings. The order held that 20 measures were unlawful, per Centene’s complaint. The government appealed to the Eleventh Circuit on July 21, per the CVS complaint filed Oct 26.

Centene’s complaint says CMS then left the struck measures out of Clover’s 2027 ratings but kept them for everyone else. “CMS has effectively conceded the validity of the legal arguments underlying this case,” it says.

At least five insurers have now sued over 2027 stars, per their complaints. Each challenges a different set of measures:

• CVS Health: 28 measures
• Centene: 17 measures
• Alignment Healthcare: 10 measures
• SCAN Health Plan: 10 measures
• Healthfirst: 5 measures

CVS filed Oct 26 in the same Brunswick court, and Judge Wood has that case too, per the Georgetown tracker. CVS says the ratings cost it more than $2 billion, as covered in CVS sues CMS over star ratings, says $2 billion at stake. Alignment says 100% of its members were in plans rated 4 stars or higher in 2026. CMS rated its 2027 contracts 3.5 and 4 stars, per Alignment’s complaint filed Oct 9.

What it means if you are shopping for a plan

Open enrollment runs Oct 15 to Dec 7, per Medicare.gov. The ratings on Plan Finder today are the ones CMS published on Oct 8. A lawsuit does not change them unless a court orders it.

Look at the overall rating and check for the low performance icon next to any plan you are weighing. Then compare drug coverage, doctors and costs the way you would in any year.

Why it matters: Star ratings decide which plans get bonus money that can turn into extra benefits. At least five insurers have now sued over the 2027 scores. A ruling for them would change who gets 2028 bonus money.