Clover Health Secures 4-Star Rating, Guides $50–$70M Adjusted EBITDA in 2026
Clover Health’s Medicare Advantage membership rose 38% year-over-year to 113,803 members in Q4 2025, earning a 4-Star CMS rating covering 97% of its PPO plan lives. The company generated $22 million in adjusted EBITDA last year and forecasts $50–$70 million in adjusted EBITDA and breakeven to $20 million net income in 2026.
1. Membership Growth and Star Rating
Clover delivered 38% year-over-year Medicare Advantage enrollment growth in Q4 2025, closing with 113,803 members. The 4-Star CMS rating on its flagship PPO plan now applies to 97% of those members, unlocking higher bonus payments and improved plan-level economics.
2. Profitability and 2026 Guidance
In 2025, Clover reported $22 million in adjusted EBITDA, reflecting tighter cost management and operational efficiencies. Management expects 2026 to be its first full year of GAAP profitability, forecasting breakeven to $20 million in net income and $50–$70 million in adjusted EBITDA, aided by a 4-Star payment year.
3. Elevated Medical Costs and Expense Ratio
Clover’s Insurance Benefit Expense Ratio rose to 90.9% in 2025, up 970 basis points, driven by higher member utilization and rollout costs for Clover Assistant–enabled care coordination. Improving BER will hinge on deeper AI-driven efficiencies and tighter medical cost controls amid competitive Medicare Advantage dynamics.
4. Regulatory and Platform Scaling Risks
The U.S. government’s projected $500 billion in Medicare spending reductions over eight years introduces reimbursement uncertainty and potential enrollment shifts. Clover must also scale its Clover Assistant and Counterpart Health platforms efficiently to convert clinical engagement into sustainable economic gains.