Contract H3251 HMO Special Needs Plan

HEALTH CARE SERVICE CORPORATION

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Blue Cross and Blue Shield of New Mexico (Health Care Service Corporation)
2.5
Overall Star Rating
2.5
Drug Plan Stars
—
Monthly Premium
1
States

What the CMS Data Shows About HEALTH CARE SERVICE CORPORATION

HEALTH CARE SERVICE CORPORATION operates under CMS contract H3251, issued by Blue Cross and Blue Shield of New Mexico (parent organization Health Care Service 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 (NM) and 33 counties, a geography set at the CMS service-area definition level.

The overall CMS Star Rating for this contract is 2.5 out of 5.0. This rating synthesizes 44 individual quality measures spanning 10 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 2.5, 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 8 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

Preventive Screenings

1 measures

Breast Cancer Screening

3

Managing Chronic Conditions

15 measures

Care for Older Adults – Medication Review

5

Care for Older Adults – Pain Assessment

2

Controlling High Blood Pressure

2

Diabetes Care – Blood Sugar Controlled

3

Diabetes Care – Eye Exam

2

Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions

4

Getting Needed Care

1

Improving Bladder Control

3

Kidney Health Evaluation for Patients with Diabetes

3

Medication Reconciliation Post-Discharge

3

Osteoporosis Management in Women who had a Fracture

1

Plan All-Cause Readmissions

4

Reducing the Risk of Falling

3

Statin Therapy for Patients with Cardiovascular Disease

1

Transitions of Care

3

Member Experience

5 measures

Complaints about the Health Plan

4

Customer Service

3

Getting Appointments and Care Quickly

1

Rating of Health Care Quality

1

Rating of Health Plan

3

Complaints & Changes

3 measures

Health Plan Quality Improvement

2

Members Choosing to Leave the Plan

4

Plan Makes Timely Decisions about Appeals

5

Customer Service

3 measures

Call Center – Foreign Language Interpreter and TTY Availability

3

Call Center – Foreign Language Interpreter and TTY Availability

4

Reviewing Appeals Decisions

4

Drug Plan Customer Service

1 measures

Complaints about the Drug Plan

4

Drug Plan Experience

2 measures

Getting Needed Prescription Drugs

1

MPF Price Accuracy

5

Drug Safety & Pricing

5 measures

Medication Adherence for Cholesterol (Statins)

2

Medication Adherence for Diabetes Medications

2

Medication Adherence for Hypertension (RAS antagonists)

2

MTM Program Completion Rate for CMR

4

Statin Use in Persons with Diabetes (SUPD)

1

Tests & Vaccines

6 measures

Annual Flu Vaccine

4

Colorectal Cancer Screening

4

Improving or Maintaining Mental Health

5

Improving or Maintaining Physical Health

5

Monitoring Physical Activity

3

Special Needs Plan (SNP) Care Management

2

Member Complaints and Changes in the Drug Plan’s Performance

3 measures

Drug Plan Quality Improvement

1

Members Choosing to Leave the Plan

4

Rating of Drug Plan

2

Supplemental Benefits

BenefitCoveredMax BenefitCopay
Hearing Aids✓ Yes——
Hearing Exam✓ Yes——
Vision — Eye Exam✓ Yes——
Vision — Eyewear✓ Yes——

Medicare Advantage Star Rating Distribution

Percentage of Medicare Advantage plans at each CMS star rating level (2026 plan year)

8%5-Star Plans
38%4-Star Plans
34%3-Star Plans
14%2-Star Plans
6%1-Star Plans

Source: CMS Medicare Advantage Star Ratings 2026. Distribution reflects national plan-county records.

County Availability

NM
Bernalillo, NM Catron, NM Chaves, NM Cibola, NM Colfax, NM Curry, NM DeBaca, NM Dona Ana, NM Eddy, NM Grant, NM Guadalupe, NM Harding, NM Hidalgo, NM Lea, NM Lincoln, NM Los Alamos, NM Luna, NM McKinley, NM Mora, NM Otero, NM Quay, NM Rio Arriba, NM Roosevelt, NM San Juan, NM San Miguel, NM Sandoval, NM Santa Fe, NM Sierra, NM Socorro, NM Taos, NM Torrance, NM Union, NM Valencia, NM

Medicare Advantage Guides

Understanding Star Ratings How to Choose a Plan Dental, Vision & Hearing Benefits MA vs Original Medicare

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Frequently Asked Questions

What is the star rating for HEALTH CARE SERVICE CORPORATION?

HEALTH CARE SERVICE CORPORATION (Contract H3251) by Blue Cross and Blue Shield of New Mexico has an overall CMS star rating of 2.5 out of 5. Star ratings are based on quality measures including preventive care, chronic disease management, and member satisfaction.

How much does HEALTH CARE SERVICE CORPORATION cost per month?

HEALTH CARE SERVICE CORPORATION has a monthly premium of data not available. Plan costs may vary by county.

What type of plan is HEALTH CARE SERVICE CORPORATION?

HEALTH CARE SERVICE CORPORATION is a HMO Medicare Advantage plan offered by Blue Cross and Blue Shield of New Mexico. 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 HEALTH CARE SERVICE CORPORATION available?

HEALTH CARE SERVICE CORPORATION is available in 1 state (NM) across 33 counties. Coverage area can vary — check with the insurer or Medicare.gov for exact availability in your ZIP code.

What supplemental benefits does HEALTH CARE SERVICE CORPORATION offer?

HEALTH CARE SERVICE CORPORATION covers 8 supplemental benefits beyond standard Medicare, including hearing aids, hearing exam, vision eye exam, vision eyewear. Many Medicare Advantage plans include dental, vision, and hearing coverage not available under Original Medicare.

How is HEALTH CARE SERVICE CORPORATION rated on quality measures?

CMS evaluates HEALTH CARE SERVICE CORPORATION across 44 individual quality measures spanning 10 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: H3251. Last updated: 2026 plan year.

Important: PlainMedicare provides CMS data for informational purposes only. This is not medical or insurance advice. Consult a licensed Medicare counselor or insurance agent for personalized guidance. Always verify current plan details with the insurer or Medicare.gov before enrolling.

Read our methodology — how this data is sourced, computed, and verified.

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Data sourced from official U.S. government datasets. See our methodology for details. Retrieved and formatted by Kiznis Studio Editorial