Clover Health Posts 38% Q4 Enrollment Growth, Seeks GAAP Profitability in 2026
Clover Health posted 38% Q4 2025 Medicare Advantage enrollment growth and secured a 4-Star CMS PPO plan rating for bonus payments. The company delivered $22 million adjusted EBITDA, with guidance to GAAP breakeven to $20 million net income and $50–70 million adjusted EBITDA in 2026, a 90.9% benefit expense ratio.
1. Membership Growth and Star Ratings
Clover Health expanded its Medicare Advantage membership by 38% year-over-year in Q4 2025, reaching over 113,800 enrollees. Earning a 4-Star CMS rating on its flagship PPO plan, which covers more than 95% of members, qualifies the company for higher quality bonus payments and strengthens plan-level economics.
2. Profitability Guidance and EBITDA Momentum
The company generated $22 million in adjusted EBITDA for 2025 and forecasts GAAP net income between breakeven and $20 million in 2026, alongside $50–70 million in adjusted EBITDA. Key drivers include a 4-Star payment year covering 97% of members, a favorable Part C rate notice, deeper engagement with its AI-powered Clover Assistant, and improved unit economics through cost-efficient member acquisition.
3. Cost Pressures and Regulatory Challenges
Clover reported a 90.9% insurance benefit expense ratio in 2025, up 970 basis points year-over-year, due in part to a new Assistant-enabled affiliated entity rollout and higher inpatient utilization. The company faces regulatory headwinds from automatic Medicare funding cuts of 4% starting in 2026 and potential Medicaid reductions affecting low-income beneficiary enrollment.