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Can Elevance Recover $115 Million Through Its CMS Lawsuit?
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Key Takeaways
Elevance sued CMS over a Medicare Advantage Star Ratings change it says favored a competitor.
ELV says the disputed ratings decision cost about $115 million in Medicare Advantage bonus payments.
A ruling could reshape CMS' ratings process and affect insurer payments and competitive positioning.
Elevance Health, Inc. (ELV - Free Report) recently filed a lawsuit against the Centers for Medicare & Medicaid Services (CMS), arguing that the agency unfairly changed the Medicare Advantage Star Ratings of one of its competitors after the ratings had already been finalized. Per reports, Elevance claims CMS gave the rival special treatment by recalculating its scores under a different standard while denying similar relief to other insurers.
The company indicates the move created an uneven competitive landscape. Through the lawsuit, Elevance is asking the court to overturn CMS' decision and restore a consistent ratings process for all Medicare Advantage insurers, according to reports.
The dispute centers on Medicare Advantage Star Ratings, which measure plan quality and directly affect bonus payments, marketing strength and member enrollment. According to the lawsuit, CMS revised a competitor's (Clover Health) ratings after identifying an error in its calculations but refused to apply the same approach across the broader industry. ELV estimates the disputed decision cost it about $115 million in Medicare Advantage quality bonus payments.
Elevance argues that once ratings are released, all insurers should be treated under the same rules instead of making company-specific adjustments. The outcome could have meaningful financial consequences for Elevance and other Medicare Advantage insurers.
Higher Star Ratings unlock quality bonus payments from CMS, improve rebate funding and make health plans more attractive during enrollment. Federal spending on Medicare Advantage quality bonuses is expected to top $13 billion this year, rising from 2025 even as the percentage of members in high-performing plans declines, per KFF.
If the court sides with Elevance, CMS could be forced to revisit its ratings process, potentially affecting payments and competitive positioning across the industry. If CMS prevails, the disputed ratings would remain in place, leaving Elevance at a competitive disadvantage against the benefited rival. The case also adds regulatory uncertainty for insurers that rely heavily on Medicare Advantage for future earnings growth.
ELV’s Price Performance
Elevance Health shares have gained 19.2% in the past year compared with the 1.4% rise of the industry.
The Zacks Consensus Estimate for CVS Health’s 2026 bottom line suggests 10.2% year-over-year growth. CVS has witnessed 12 upward estimate revisions over the past 60 days against no movement in the opposite direction. It beat earnings estimates in all the last four quarters, with an average surprise of 16.8%.
The Zacks Consensus Estimate for Pediatrix Medical’s full-year 2026 earnings indicates a 9.3% year-over-year increase. MD beat earnings estimates in three of the past four quarters and missed once, with an average surprise of 21.3%. The consensus mark for revenues suggests 1.3% growth from the year-ago period.
The Zacks Consensus Estimate for Biodesix’s 2026 full-year earnings implies a 37.7% improvement from the year-ago reported figure. BDSX beat earnings estimates in three of the last four quarters and missed once, with an average surprise of 25.6%. The consensus mark for its current-year revenues is pegged at $110.95 million, which indicates a 25.4% year-over-year increase.
View the Zacks #1 Rank List
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Can Elevance Recover $115 Million Through Its CMS Lawsuit?
Key Takeaways
Elevance Health, Inc. (ELV - Free Report) recently filed a lawsuit against the Centers for Medicare & Medicaid Services (CMS), arguing that the agency unfairly changed the Medicare Advantage Star Ratings of one of its competitors after the ratings had already been finalized. Per reports, Elevance claims CMS gave the rival special treatment by recalculating its scores under a different standard while denying similar relief to other insurers.
The company indicates the move created an uneven competitive landscape. Through the lawsuit, Elevance is asking the court to overturn CMS' decision and restore a consistent ratings process for all Medicare Advantage insurers, according to reports.
The dispute centers on Medicare Advantage Star Ratings, which measure plan quality and directly affect bonus payments, marketing strength and member enrollment. According to the lawsuit, CMS revised a competitor's (Clover Health) ratings after identifying an error in its calculations but refused to apply the same approach across the broader industry. ELV estimates the disputed decision cost it about $115 million in Medicare Advantage quality bonus payments.
Elevance argues that once ratings are released, all insurers should be treated under the same rules instead of making company-specific adjustments. The outcome could have meaningful financial consequences for Elevance and other Medicare Advantage insurers.
Higher Star Ratings unlock quality bonus payments from CMS, improve rebate funding and make health plans more attractive during enrollment. Federal spending on Medicare Advantage quality bonuses is expected to top $13 billion this year, rising from 2025 even as the percentage of members in high-performing plans declines, per KFF.
If the court sides with Elevance, CMS could be forced to revisit its ratings process, potentially affecting payments and competitive positioning across the industry. If CMS prevails, the disputed ratings would remain in place, leaving Elevance at a competitive disadvantage against the benefited rival. The case also adds regulatory uncertainty for insurers that rely heavily on Medicare Advantage for future earnings growth.
ELV’s Price Performance
Elevance Health shares have gained 19.2% in the past year compared with the 1.4% rise of the industry.
Zacks Rank & Other Key Picks
Elevance Health currently has a Zacks Rank #2 (Buy). Some other top-ranked stocks in the broader Medical space are CVS Health Corporation (CVS - Free Report) , Pediatrix Medical Group, Inc. (MD - Free Report) and Biodesix, Inc. (BDSX - Free Report) , each carrying a Zacks Rank #2 at present. You can see the complete list of today’s Zacks #1 Rank (Strong Buy) stocks here.
The Zacks Consensus Estimate for CVS Health’s 2026 bottom line suggests 10.2% year-over-year growth. CVS has witnessed 12 upward estimate revisions over the past 60 days against no movement in the opposite direction. It beat earnings estimates in all the last four quarters, with an average surprise of 16.8%.
The Zacks Consensus Estimate for Pediatrix Medical’s full-year 2026 earnings indicates a 9.3% year-over-year increase. MD beat earnings estimates in three of the past four quarters and missed once, with an average surprise of 21.3%. The consensus mark for revenues suggests 1.3% growth from the year-ago period.
The Zacks Consensus Estimate for Biodesix’s 2026 full-year earnings implies a 37.7% improvement from the year-ago reported figure. BDSX beat earnings estimates in three of the last four quarters and missed once, with an average surprise of 25.6%. The consensus mark for its current-year revenues is pegged at $110.95 million, which indicates a 25.4% year-over-year increase.