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Clover Health
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Latest analysis
Updated Nov 6, 2026
Clover Health posts first nine-month GAAP profit as MA membership surges 49% and BER compresses 100bps to 88.4%
Clover Health inflected to GAAP profitability in the nine months ended September 30, 2026, reporting net income of $61.8 million against a $36.2 million loss in the prior-year period, driven by 49% average membership growth and a ~7% increase in per-member premium from the step-up to 4.0 Stars payment for its PPO plans. The Insurance Benefits Expense Ratio improved 100 basis points year-over-year to 88.4% for the nine-month period, while Adjusted EBITDA more than doubled to $97.2 million, demonstrating that revenue is scaling faster than medical costs and administrative spend. A court-ordered Star Ratings recalculation elevated both PPO and HMO contracts to 4.5 Stars for payment year 2027, with the PPO receiving 5 Stars for payment year 2028, creating a multi-year premium tailwind that is now under CMS appellate review.
Tone: bullishRevenue
$1.9B
CLOV 10-K · FY 2025
Employees
724
Revenue FY2024
$1.4B
Founded
2019
Profile
CLOV 10-K Item 1 · Feb 27, 2026Clover Health operates Medicare Advantage PPO and HMO plans in five states, differentiated by its proprietary AI-powered physician-enablement platform, Clover Assistant. The platform synthesizes data from over 100 sources to deliver personalized, real-time clinical recommendations at the point of care, helping physicians identify and manage chronic diseases earlier. Through its subsidiary Counterpart Health, the company is extending Clover Assistant externally as a SaaS product to third-party payors and providers serving the Medicare-eligible population.
Read filing description ↓ Collapse description ↑
At Clover Health, our vision is to empower every physician with technology to identify, manage, and treat chronic diseases earlier. This results in earlier diagnosis and treatment, earlier disease management and more affordable and accessible care. Our strategy is to improve the care of our Medicare Advantage ('MA') members, develop wide physician networks, and provide technology to help empower physicians. Our proprietary software platform, Clover Assistant (licensed externally as Counterpart Assistant), supports clinical real-time decision making at the point of care by equipping the clinical with data and insights. This helps us execute our strategy by enabling physicians to detect, identify, and manage chronic diseases better than they otherwise could. This technology is a cloud-based software platform that curates data from over 100 sources and provides physicians with access to data-driven insights and personalized care recommendations for the patients. We leverage Clover Assistant in our Preferred Provider Organization ('PPO') and Health Maintenance Organization ('HMO') plans. We aim to provide affordable, high-quality healthcare and we offer most of our members in our Medicare Advantage plans among the lowest average out-of-pocket costs for primary care provider and specialist co-pays in their respective markets. We strongly believe in providing our members with provider choice and consider our PPO plans to be our flagship insurance product. At January 1, 2026, we operated our MA plans in five states and 203 counties. During 2024, the Company launched Counterpart Health, Inc., a new Software-as-a-Service and Tech Enabled Services Solution to bring the power of Clover Assistant technology to external payors and providers serving the Medicare eligible population. Counterpart Health is complementary to Clover Health, and enables the Company to deploy and expand the reach of its existing technology asset for new potential growth and high margin business opportunities, with low startup costs.
Primary products
- Clover Assistant
- Counterpart Assistant
- PPO Medicare Advantage plans
- HMO Medicare Advantage plans
- Clover Home Care
- Counterpart Health SaaS platform
Business segments
End markets
Geographies
Named customers
Named competitors
“We believe our business model allows us to compete favorably based on the following competitive factors: the use of Clover Assistant platform to improve clinical decision-making, price, quality of service, products offering access to broad and open provider networks, breadth and flexibility of plan benefits, brand strength, beneficiary and provider satisfaction, and financial stability.” Competitive position, as stated in the filing
Revenue commentary · FY 2025
Total revenues grew from $1.37 billion in 2024 to $1.92 billion in 2025, driven by membership expansion and higher premiums earned net.
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