As incumbent Medicare Advantage (MA) plans grapple with cost pressures and the threat of flat 2027 rates, smaller players have an opportunity to thrive, Clover Health CEO Andrew Toy told investors Thursday.
Toy said during the company’s earnings call that if the largest players choose to exit markets and restrict benefits in the face of MA headwinds, it serves to strengthen Clover’s competitiveness as well as underscore the value of the investments it’s made.
Clover is built on its Clover Assistant tool and tech stack, which aim to support clinicians during visits with patients. Toy also said the team has long advocated for greater oversight in risk adjustment as its clinical model lacks the incentive for upcoding.
“When the broader market faces pressure, it reinforces the durability of our model and the structural choices we made,” he said.
During Medicare’s annual enrollment period, Clover grew its membership by 53% year over year, Toy said. Per the company’s earnings report, Clover boasted 113,803 members as of Dec. 31, up from 82,664 at the end of 2024.
Revenues in the fourth quarter were $487.7 million, up significantly from the $337 million haul reported in the fourth quarter of 2024. Full-year revenues were $1.9 billion, growing from 2024’s $1.4 billion, according to the report.
The company also reported a $23.8 million loss in the fourth quarter, compared to a slim $7.4 million profit in the fourth quarter of 2024. It was profitable across all of 2025, however, posting $20 million in profits.
By comparison, Clover reported $68.2 million in profit for 2024, making for a decrease of 70.7%, according to the earnings report.
In addition, Clover said its medical loss ratio (MLR) was 95% in the fourth quarter and 90.9% for the full 2025. In the fourth quarter of 2024, MLR was 82.8%, while 2024’s full-year MLR was 81.2%.
For 2026, Clover expects to bring in between $2.81 billion and $2.92 billion in revenue, equaling growth of 49% year over year. It also projects adjusted earnings before interest, taxes, depreciation and amortization of between $50 million and $70 million.
It estimates membership will grow to between 154,000 and 158,000, for 46% growth.
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