Clover Health
Clover Health is a publicly traded Medicare Advantage insurer using its proprietary Clover Assistant AI platform to deliver PPO/HMO plans to seniors in five states, with a SaaS subsidiary (Counterpart Health) licensing the same AI to external providers.
- Company typePublic
- Founded2014
- HeadquartersNashville, United States
- Headcount501–1,000
- GTM typeB2B and B2C
- OfferingServices
What Clover Health does
Clover Health is a publicly traded Medicare Advantage insurer (NASDAQ: CLOV) operating PPO and HMO plans with $0 premiums in five states and 203 counties as of January 2026, serving 155,773 MA members in Q1 2026. Its core technology is the Clover Assistant platform, an AI-powered clinical decision support tool that ingests over 100 clinical data sources to surface real-time insights for primary care physicians at the point of care. The platform underpins the company's medical cost management (~$2.92B FY2026 revenue guidance, Q1 2026 GAAP net income of $27.3M) and was spun out in 2024 as Counterpart Health, a SaaS subsidiary licensing the same AI to external payers and providers.
The business operates on a hybrid revenue model. Premiums from CMS for Medicare Advantage coverage (~$744.2M of $749.2M in Q1 2026 revenue) constitute the primary recurring stream, supplemented by a nascent Counterpart Health SaaS line (over 450% YoY growth in live clinicians) that licenses the same AI capabilities to third parties. Go-to-market is multi-channel: direct phone sales, online and CMS enrollment centers, a broker/agent network, and provider referrals.
Recent strategic milestones include a federal court-ordered CMS Star Rating upgrade to 4.5 stars (June 2026), becoming the first payer live on a CMS Aligned Network/TEFCA (March 2026), and MA membership growth of 51% YoY. Key risks include structural CMS premium concentration, ongoing MA rate pressure, a CFO transition (March 2026), and execution on the Counterpart Health SaaS expansion thesis.
Clover Health firmographics
Firmographics- Name
- Clover Health
- Legal name
- Clover Health Investments, Corp.
- Website
- http://cloverhealth.com
- Company type
- Public
- Founded year
- 2014
- Operating status
- Operating
- Headcount range
- 501–1,000 employees
- Short description
- Clover Health is a publicly traded Medicare Advantage insurer using its proprietary Clover Assistant AI platform to deliver PPO/HMO plans to seniors in five states, with a SaaS subsidiary (Counterpart Health) licensing the same AI to external providers.
- Ownership category
- akta.pro rank
Clover Health industry classification
Industry- Product category
- Medicare Advantage Health Insurance
- NAICS
- Continuing Care Retirement Communities (623311), Health and Welfare Funds (525120)
- SIC
- Accident & Health Insurance (6321), Hospital & Medical Service Plans (6324)
- akta.pro primary industry
- Medicare Advantage HMOs (HMO/HMO-POS) (HLAEAMAH)
- akta.pro secondary industries
- Geriatric, Frailty & Fall-Prevention Remote Monitoring (HLALAFAI), D-SNP Supplemental Benefits & Flex Card/OTC Administration (HLAEAFAN)
Keywords
Where Clover Health is headquartered
LocationHeadquarters
- HQ city
- Nashville
- HQ country
- United States
- HQ region
- North America
Offices5 records
Markets served
Clover Health business model
Business model- GTM type
- B2B and B2C
- Offering type
- Services
- Cost components
- Operations, Personnel, Technology or R&D, Marketing or Sales, Infrastructure
Revenue model
- Medicare Advantage Premiums: Primary revenue stream from Medicare Advantage plan premiums. Clover collects premiums from CMS based on member enrollment and risk adjustment, with revenue growing 62% year-over-year to $749.2 million in Q1 2026. Premium revenue was $744.2 million in Q1 2026 out of $749.2 million total revenue.
- SaaS/Software (Counterpart Health): Revenue from licensing the Counterpart Health platform to external healthcare providers and payers. The company aims to expand external software business to match Medicare Advantage membership within three years, with over 450% year-over-year growth in live clinicians.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Monthly | $0 Premium PPO Plans |
Go-to-market motion1 record
Distribution channels4 records
Marketing channels6 records
Clover Health product offering
Product offeringCore offering
Clover Health offers Medicare Advantage PPO and HMO insurance plans to seniors, with $0 to low monthly premiums and supplemental benefits including dental, vision, hearing, OTC allowances, and fitness memberships. The plans are supported by the proprietary Clover Assistant AI platform that delivers real-time clinical decision support to physicians by connecting over 100 clinical data sources, and the company has spun out Counterpart Health as a SaaS subsidiary offering this physician-enablement technology to external healthcare providers.
Product overview
Clover Health is a Medicare Advantage insurer offering PPO and HMO plans augmented by technology platforms. The core product is the Medicare Advantage plan portfolio, supported by the proprietary Clover Assistant platform for clinical decision support. The company operates Counterpart Health as a separate SaaS subsidiary offering the same AI-powered physician enablement technology (Counterpart Assistant) to third-party healthcare providers. Additional offerings include the LiveHealthy Rewards program, Availity Essentials provider portal, and public APIs for formulary, provider directory, and patient health data access.
Differentiator
Problem solved
Functional benefit
Brands
- Clover Assistant: AI-powered clinical support tool that provides real-time insights at point of care, connecting over 100 clinical data sources to support primary care physicians
- Counterpart Health
- LiveHealthy Rewards Program
Products and services
- Clover Health Medicare Advantage Plans Medicare Advantage PPO and HMO insurance plans covering hospitals, doctors, and prescription drugs (Part D), with supplemental benefits including dental, vision, hearing, OTC allowances, and fitness memberships. Plans feature $0 to low monthly premiums and no referral requirements for specialist visits, designed for Medicare-eligible seniors aged 65 and older.
- Clover Assistant Clinical decision support AI platform that collects, structures, and analyzes health and behavioral data to improve medical outcomes and lower costs. Connects over 100 clinical data sources to provide physicians with real-time insights at the point of care, driving earlier diagnoses and reduced hospitalizations for primary care physicians.
- Counterpart Health SaaS Platform Wholly-owned subsidiary SaaS platform offering AI-powered physician enablement technology (Counterpart Assistant and HEDIS quality measurement platform) to healthcare providers and payers outside of Clover's own Medicare Advantage plans. Achieves approximately 1,500 basis point improvements in Medical Cost Ratio for clinicians using the platform versus non-users.
- LiveHealthy Rewards Program Member rewards program allowing Clover Health Medicare Advantage members to earn up to $400 annually through health-related activities including completing health surveys, wellness visits, preventive care, and fitness activities. Reward dollars are loaded onto a LiveHealthy Flex Plus card and can be used at most Visa acceptance locations.
Quantifiable outcome
- 7.6-21.2% fewer all-cause hospitalizations for patients whose PCPs use Counterpart Assistant AI versus control group
- +5 more outcomes
Companies that use Clover Health
Customer profileNamed customers1 record
Segments3 records
Ideal customer profiles3 records
Clover Health technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- Yes
- API docs
- API detail
Core technology
AI maturity
App detail
Integration5 records
AI capability4 records
Feature6 records
Clover Health partnerships and signals
Strategic signalPartnerships
Seven partnerships are on record, tiered core and minor.
- Kno2coreClover Health partnered with Kno2 to become the first payer to go live on a CMS Aligned Network and TEFCA, enabling real-time patient access to clinical and claims data through standardized FHIR formats. The collaboration supports federal interoperability initiatives and allows patients to securely authenticate and request health information through a connected network.
- DentaQuestcoreDental network partner providing dental benefits to Clover Health Medicare Advantage members. Covers preventive and comprehensive dental services including cleanings, X-rays, extractions, root canals, crowns, bridges, and fillings.
- EyeQuestcoreVision network partner covering routine eye exams and annual allowances for glasses or contact lenses for Clover Health members.
- TruHearingcoreHearing aid partner offering members hearing aids starting at $499 per device, along with routine hearing exams and two hearing aids per year.
- HumanaminorPotential partnership where Humana is deploying Counterpart Assistant into its digital infrastructure, with both companies sharing a 3-year cost-saving target. Not yet confirmed as formal partnership.
- One PassminorFitness membership program included with Clover Health plans, providing access to national network of premium gyms, over 20,000 on-demand fitness classes, and brain training games.
- AvailitycoreProvider portal partnership enabling providers to access Availity Essentials for eligibility checks, benefits review, and administrative tasks. Live as of 2025.
Scale indicators10 records
Recent moves10 records
Expansion highlights5 records
Clover Health competitors and assessment
Company assessmentEmerging players
- Privia Health: Physician enablement and medical group platform with multi-payer risk arrangements. Comparable to Counterpart Health as a tech-enabled platform serving PCPs in value-based care.
- agilon health: Value-based physician enablement platform partnering with senior-focused PCPs and MA plans. Adjacent to Counterpart Health's SaaS thesis and Clover Assistant's PCP-focused deployment model.
Direct peers
- Oscar Health: Technology-first health insurance company offering individual ACA and Medicare Advantage plans with its own care management platform (+Oscar). Comparable as a public, tech-led payer with similar profitability trajectory.
- Alignment Healthcare: Tech-enabled Medicare Advantage insurer focused on seniors in select U.S. states with an AI-driven care coordination platform. Highly comparable to Clover's MA-plus-software model and similar scale/stage.
Broad incumbents
- Molina Healthcare: Government-sponsored managed care company with Medicare Advantage and dual-eligible plans. Comparable as a focused government-program payer, though less technology-centric than Clover.
- Humana: Largest pure-play Medicare Advantage insurer in the U.S. with ~5M MA members. Reference incumbent for MA economics, Star Ratings, and broker distribution — and noted potential Counterpart partner.
- UnitedHealth Group: Largest U.S. health insurer and the dominant Medicare Advantage player via UnitedHealthcare. Benchmarks scale, Optum integration, and provider leverage that Clover must compete against.
- Elevance Health: Large multi-state Blue Cross Blue Shield licensee with a sizable Medicare Advantage business and growing Carelon services arm. Comparable in MA product breadth and data infrastructure investments.
- CVS Health (Aetna): Major Medicare Advantage insurer through Aetna, with vertical integration into pharmacy (Caremark) and clinics (Oak Street). Defines the upper bound of scaled, vertically integrated MA competitors.
- Centene: Largest U.S. Medicaid managed-care insurer with a growing Medicare Advantage presence (Wellcare). Comparable government-program payer competing in overlapping dual-eligible and MA markets.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat6 records
Key risks6 records
Key highlights7 records
Customer concentration
Clover Health social profiles
Digital presenceClover Health compliance and trust
Trust signalCompliance3 records
Clover Health financial estimates
Financial estimateRevenue estimate
Valuation estimate
Clover Health leadership team
Management profileNumber of profiles
Profiles7 records
Clover Health subsidiaries and ownership
Company hierarchySubsidiaries1 record
Clover Health funding detail
Funding detailFunding overview
Funding rounds8 records
Investors30 records
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Clover Health M&A and investment
M&A and investmentM&A
Investments2 records
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Clover Health
What does Clover Health do?
Clover Health offers Medicare Advantage PPO and HMO insurance plans to seniors, with $0 to low monthly premiums and supplemental benefits including dental, vision, hearing, OTC allowances, and fitness memberships. The plans are supported by the proprietary Clover Assistant AI platform that delivers real-time clinical decision support to physicians by connecting over 100 clinical data sources, and the company has spun out Counterpart Health as a SaaS subsidiary offering this physician-enablement technology to external healthcare providers.
Is Clover Health a public or private company?
Clover Health is a public company. It is classified as public and is currently operating.
When was Clover Health founded?
Clover Health was founded in 2014. It employs 501 to 1,000 people.
Where is Clover Health based?
Clover Health is headquartered in Nashville, United States, in the North America region.
How does Clover Health make money?
Two revenue lines are on record. Medicare Advantage Premiums are the primary driver. The others are saaS/Software (Counterpart Health).
Who are Clover Health's main competitors?
Emerging players on record are Privia Health and agilon health. Direct peers are Oscar Health and Alignment Healthcare. Broad incumbents are Molina Healthcare, Humana, UnitedHealth Group, Elevance Health, CVS Health (Aetna) and Centene.
Does Clover Health have an API?
Yes. Clover Health supports three public APIs for use in third-party applications: (1) Formulary API allows access to medication data available to Clover members; (2) Provider Directory API provides access to provider data defining which doctors Clover members can use; (3) Patient Access API enables access to a Clover member's health information once the member consents to its use. APIs are subject to the Information Blocking provisions at 45 CFR Part 171 (ONC regulation) and the CMS Interoperability and Patient Access Final Rule (CMS-9115-F). Developers must register with Clover, and Patient Access API requires Privacy Policy and Terms of Use documentation. Patient data revocation is supported, with access disabled if data hasn't been actively used within three months. Developer documentation is at public-api.cloverhealth.com/swagger.
What industry is Clover Health in?
Clover Health's product category is Medicare Advantage Health Insurance. Its primary akta.pro industry code is HLAEAMAH, Medicare Advantage HMOs (HMO/HMO-POS), with a secondary code of HLALAFAI, Geriatric, Frailty & Fall-Prevention Remote Monitoring. Its NAICS code is 623311 and its SIC code is 6321.