CVS sues CMS over star ratings, says $2 billion at stake

CVS Health says the government’s 2027 Medicare Advantage star ratings will cost it more than $2 billion in 2028 bonus payments and rebate money. That figure is in a complaint CVS and its Aetna and SilverScript plan companies filed Oct 26 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 CVS is asking for

CMS published the 2027 ratings on Oct 8. CVS says 43 of its contracts scored lower than they should have because CMS counted 28 measures it had no right to use. Those contracts cover about 7,033,760 members, the complaint says.

CVS argues some measures were never put through public notice and comment. It says 12 others rely on data the Medicare law does not let CMS use for star ratings.

The complaint says every one of the 43 contracts would score at least half a star higher without the 28 measures. By the complaint’s own table, 29 of the contracts sit below 4 stars today. Twenty five of those would reach 4 or more.

CVS also says its company wide average would rise from 4 stars to 4.5. That average sets the rating on three newer contracts.

Where the money is

Star ratings run from 1 to 5 and sit next to every plan on Medicare Plan Finder. Plans at 4 stars or higher get a quality bonus. Rebate money rises with the score too. Plans below 3.5 stars keep 50% of their rebate. Plans from 3.5 to under 4.5 keep 65%. Plans at 4.5 and up keep 70%.

The biggest single loss, per CVS, is contract H3959, run by Aetna Health Inc. in Pennsylvania, Delaware and Georgia. It serves 206,058 members and got 3.5 stars. CVS puts its loss at $361,068,250.

The largest contract in the suit is S5601, SilverScript’s Part D drug plan. It serves 3,875,193 members across the country.

CVS’s Health Care Benefits segment, which includes Aetna, made $1.793 billion in operating income in 2025, per CVS’s full year 2025 results. The $2 billion claim is larger than that. Aetna said Oct 8 that more than 69% of its Medicare Advantage members are in 2027 plans rated 4 stars or higher.

The case it is leaning on

The same court ruled for Clover Health on May 27, 2026, and ordered CMS to redo Clover’s ratings. The government appealed July 21, the complaint says.

CVS is at least the fifth insurer to sue over 2027 stars, per the complaints on the Georgetown tracker. Alignment Healthcare filed Oct 9, Healthfirst Oct 19, Centene Oct 22 and SCAN Oct 26. Centene puts its own cost at about $448 million.

Every 2027 star ratings suit so far

We read all five complaints. Each insurer puts its own price on its 2027 ratings, and CVS claims more than the other four combined. Together the five claim more than $3.1 billion in 2028 bonus and rebate money. No court had ruled on any of them as of Oct 31, per the Georgetown tracker.

Chart: Health and Tech Now. Dollar figures are each insurer’s own estimate in its complaint. Sources: complaints by Alignment Healthcare (D.D.C. No. 1:26-cv-03550, Oct 9, 2026), Healthfirst (S.D.N.Y. No. 1:26-cv-09158, Oct 19), Centene (S.D. Ga. No. 2:26-cv-00113, Oct 22), SCAN Health Plan (D.D.C. No. 1:26-cv-03737, Oct 26) and CVS Health (S.D. Ga. No. 2:26-cv-00115, Oct 26), via the Georgetown O’Neill Health Care Litigation Tracker.

Insurers file 2028 bids in June 2027, and the 2027 ratings set the bonus and rebate money in those bids.

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.

Check the overall rating on any plan you are weighing. Then compare drug coverage, doctors and costs the way you would in any year.

Why it matters: The largest Medicare drug plan in this suit covers almost 3.9 million people. At least five insurers now want a judge to rewrite their 2027 scores. If they win, star ratings get set one lawsuit at a time.