METROPLUS HEALTH PLAN, INC.
What the CMS Data Shows About METROPLUS HEALTH PLAN, INC.
METROPLUS HEALTH PLAN, INC. operates under CMS contract H0423, issued by MetroPlus Health Plan (parent organization New York City Health and Hospitals Corporation). The contract is classified as a HMO product, which governs how enrollees access care: HMOs require in-network providers and referrals for most specialist care, trading network flexibility for lower cost-sharing. This contract is also flagged in CMS data as a Special Needs Plan (SNP), meaning enrollment is restricted to beneficiaries meeting specific eligibility criteria — chronic condition, dual Medicare-Medicaid status, or institutional residence. Service area spans 1 state (NY) and 5 counties, a geography set at the CMS service-area definition level.
The overall CMS Star Rating for this contract is 3.5 out of 5.0. This rating synthesizes 42 individual quality measures spanning 9 CMS domains, including clinical outcomes, patient experience (CAHPS), member complaints and appeals, and plan operations. The Part D drug-benefit portion of this contract carries a separate CMS Star Rating of 3.5, which reflects pharmacy cost, adherence to chronic medications, and drug pricing accuracy. Ratings at 4+ stars trigger federal Quality Bonus Payments that insurers typically reinvest in supplemental benefits.
On costs, this contract lists a monthly plan premium of not reported. Beyond standard Medicare Parts A and B, the contract documents 7 supplemental benefits in the CMS benefits file — coverage extras such as dental, vision, hearing aids, fitness programs, and OTC allowances that Original Medicare does not provide. Before enrolling, verify that your preferred providers participate in the plan's network for your specific county, review the current Summary of Benefits, and confirm that your prescriptions appear on the plan formulary. All figures shown come from CMS public-use files for the 2026 contract year; this page is informational only and is not personalized Medicare counseling advice.
Quality Measures by Domain
Managing Chronic Conditions
13 measuresCare for Older Adults – Medication Review
Care for Older Adults – Pain Assessment
Controlling High Blood Pressure
Diabetes Care – Blood Sugar Controlled
Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions
Getting Needed Care
Improving Bladder Control
Kidney Health Evaluation for Patients with Diabetes
Osteoporosis Management in Women who had a Fracture
Plan All-Cause Readmissions
Reducing the Risk of Falling
Statin Therapy for Patients with Cardiovascular Disease
Transitions of Care
Member Experience
6 measuresCare Coordination
Complaints about the Health Plan
Customer Service
Getting Appointments and Care Quickly
Rating of Health Care Quality
Rating of Health Plan
Complaints & Changes
3 measuresHealth Plan Quality Improvement
Members Choosing to Leave the Plan
Plan Makes Timely Decisions about Appeals
Customer Service
3 measuresCall Center – Foreign Language Interpreter and TTY Availability
Call Center – Foreign Language Interpreter and TTY Availability
Reviewing Appeals Decisions
Drug Plan Customer Service
1 measuresComplaints about the Drug Plan
Drug Plan Experience
2 measuresGetting Needed Prescription Drugs
MPF Price Accuracy
Drug Safety & Pricing
5 measuresMedication Adherence for Cholesterol (Statins)
Medication Adherence for Diabetes Medications
Medication Adherence for Hypertension (RAS antagonists)
MTM Program Completion Rate for CMR
Statin Use in Persons with Diabetes (SUPD)
Tests & Vaccines
6 measuresAnnual Flu Vaccine
Colorectal Cancer Screening
Improving or Maintaining Mental Health
Improving or Maintaining Physical Health
Monitoring Physical Activity
Special Needs Plan (SNP) Care Management
Member Complaints and Changes in the Drug Plan’s Performance
3 measuresDrug Plan Quality Improvement
Members Choosing to Leave the Plan
Rating of Drug Plan
Supplemental Benefits
| Benefit | Covered | Max Benefit | Copay |
|---|---|---|---|
| Hearing Aids | ✓ Yes | — | — |
| Vision — Eyewear | ✓ Yes | — | — |
| Hearing Exam | ✓ Yes | — | — |
Medicare Advantage Star Rating Distribution
Percentage of Medicare Advantage plans at each CMS star rating level (2026 plan year)
Source: CMS Medicare Advantage Star Ratings 2026. Distribution reflects national plan-county records.
Medicare Advantage Guides
Related Healthcare Data
Frequently Asked Questions
What is the star rating for METROPLUS HEALTH PLAN, INC.?
METROPLUS HEALTH PLAN, INC. (Contract H0423) by MetroPlus Health Plan has an overall CMS star rating of 3.5 out of 5. Star ratings are based on quality measures including preventive care, chronic disease management, and member satisfaction.
How much does METROPLUS HEALTH PLAN, INC. cost per month?
METROPLUS HEALTH PLAN, INC. has a monthly premium of data not available. Plan costs may vary by county.
What type of plan is METROPLUS HEALTH PLAN, INC.?
METROPLUS HEALTH PLAN, INC. is a HMO Medicare Advantage plan offered by MetroPlus Health Plan. This is also a Special Needs Plan (SNP) designed for beneficiaries with specific diseases, characteristics, or care needs. HMO plans generally require you to use in-network providers and get referrals for specialists.
Where is METROPLUS HEALTH PLAN, INC. available?
METROPLUS HEALTH PLAN, INC. is available in 1 state (NY) across 5 counties. Coverage area can vary — check with the insurer or Medicare.gov for exact availability in your ZIP code.
What supplemental benefits does METROPLUS HEALTH PLAN, INC. offer?
METROPLUS HEALTH PLAN, INC. covers 7 supplemental benefits beyond standard Medicare, including hearing aids, vision eyewear, hearing exam. Many Medicare Advantage plans include dental, vision, and hearing coverage not available under Original Medicare.
How is METROPLUS HEALTH PLAN, INC. rated on quality measures?
CMS evaluates METROPLUS HEALTH PLAN, INC. across 42 individual quality measures spanning 9 domains, including DD1: Drug Plan Customer Service, DD2: Member Complaints and Changes in the Drug Plan’s Performance, DD3: Member Experience with the Drug Plan and more. These measures cover clinical outcomes, patient experience, and plan operations.
Data Source
Data from CMS Medicare Advantage 2026 Star Ratings and Plan Finder datasets. Contract ID: H0423. Last updated: 2026 plan year.
Read our methodology — how this data is sourced, computed, and verified.