Clover Health Reports 53% Increase in Medicare Advantage Membership

In a recent announcement dated January 14, Clover Health revealed a substantial 53% increase in its Medicare Advantage PPO membership compared to the previous year. This growth brings the total to approximately 153,000 members, underscoring the company’s upward trajectory since 2025. Notably, Clover Health projects achieving full-year GAAP net income profitability, highlighting a pivotal milestone with its first profitable quarter reported in 2024.

Clover Health emphasized strong member retention, keeping over 95% of its annual enrollment period members. As of January 1, its PPO plan accounted for more than 97% of its membership, paralleling Alignment Healthcare's reported 31% increase in year-over-year membership. This trend reflects robust demand for Medicare Advantage plans amid evolving regulatory compliance requirements and shifting payer models heading into 2025.

Industry-wide Shifts and Regulatory Compliance Challenges

These developments occur amidst broader industry trends where many insurers face challenges due to AI-driven prior authorization delays and evolving regulatory compliance requirements. In a related update, Georgia regulators have imposed nearly $25 million in penalties on 11 insurers for violations of state mental health parity laws. Additionally, UnitedHealthcare has launched a pilot program to streamline claims and reduce payment processing times for Medicare Advantage by 50% within independent rural settings.

Meanwhile, Cigna remains in negotiations with Memorial Hospital in Chattanooga, part of the CommonSpirit Health network, seeking a mutual agreement amid changing carrier and provider dynamics. This information is based on Clover Health's public disclosures and additional industry news reports, illustrating key trends and developments in risk management, underwriting, and claims processes within the insurance sector.