Clover Health's proprietary software platform, Clover Assistant, is central to its strategy of empowering physicians with data-driven insights to improve chronic disease management and synthesizes comprehensive data sets to generate personalized care recommendations. As of January 1, 2026, Clover Health operated its Medicare Advantage plans in five states and 203 counties, reflecting a strategic focus on expanding its geographical footprint to reach a broader array of consumers, including traditionally underserved markets.
Cyborg Score Rationale
Clover Health is showing high top-line and membership growth alongside improving non-GAAP profitability. However, the identified major risk is less than 1 year of cash runway, so funding needs could matter if profitability timing or magnitude shifts. The path to GAAP profitability in 2026 is encouraging but execution risk remains.
Top Insights
Management projects the company could achieve its first GAAP net income in 2026, supported by growth in Medicare Advantage membership and wider use of its Counterpart Health platform by third parties.
Counterpart Health reported >450% YoY increase in live third-party customer clinicians and 1,500 basis point MCR differential for returning Clover members with CA PCPs, with earlier COPD diagnosis rates 75% higher and 18% increased outpatient pulmonology use.
Clover Health reported a 53% year-over-year increase in Medicare Advantage PPO membership for the 2026 plan year with ~153,000 members, >95% AEP retention, and ranks #1 nationally on core HEDIS metrics.
Cash, cash equivalents, and investments totaled $319.9 million at year-end 2025, down from $437.6 million a year earlier, reflecting net cash used in operations and capital returns.
Named Competitors
Medicare Advantage Plans — Leading MA insurer with broad network and scale advantages
Medicare Advantage Plans — Established MA competitor with significant member base and regional presence
Medicare Advantage Plans — Integrated healthcare provider with MA offerings and retail footprint
Recent Developments
(February 2026) Reported 2025 full-year revenue of $1.9B (+40% YoY) with 113,803 MA members (+38% YoY); guided to $2.81-$2.92B revenue for 2026 with first GAAP net income of $0-$20M
(January 2026) Achieved 53% YoY growth in Medicare Advantage membership during AEP to 153,000 members with >95% returning member retention
(January 2026) Counterpart Health reported >450% YoY increase in third-party customer clinicians and demonstrated 1,500 basis point MCR differential impact
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