Clover Health

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.

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

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

• Medicare Advantage insurance
• Healthcare technology platform
• Clinical decision support
• AI physician enablement
• Healthcare data interoperability

Headquarters

HQ city

Nashville

HQ country

United States

HQ region

North America

Offices5 records

Markets served

GTM type

B2B and B2C

Offering type

Services

Cost components

Operations, Personnel, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. 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.
2. 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

Go-to-market motion1 record

Distribution channels4 records

Marketing channels6 records

Core 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

Named customers1 record

Segments3 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration5 records

AI capability4 records

Feature6 records

Partnerships

Seven partnerships are on record, tiered core and minor.

• Kno2coreTechnology or Integration · 8 March 2026Clover 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.
• DentaQuestcoreTechnology or IntegrationDental 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.
• EyeQuestcoreTechnology or IntegrationVision network partner covering routine eye exams and annual allowances for glasses or contact lenses for Clover Health members.
• TruHearingcoreTechnology or IntegrationHearing aid partner offering members hearing aids starting at $499 per device, along with routine hearing exams and two hearing aids per year.
• HumanaminorStrategic or Co-development PartnerPotential 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 PassminorOthersFitness 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.
• AvailitycoreTechnology or IntegrationProvider 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

Emerging 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

• Xx.com/clover_health
• YouTubeyoutube.com/channel/UCLNsj-zSpHstE8xLxbj6F6g/channels
• Facebookfacebook.com/CloverHealth
• LinkedInlinkedin.com/company/cloverhealth
• Instagraminstagram.com/cloverhealth

Compliance3 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles7 records

Subsidiaries1 record

Funding overview

Funding rounds8 records

Investors30 records

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments2 records

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Clover Health