MEDICAL ASSOCIATES CLINIC HEALTH PLAN

What the CMS Data Shows About MEDICAL ASSOCIATES CLINIC HEALTH PLAN

MEDICAL ASSOCIATES CLINIC HEALTH PLAN operates under CMS contract H5256, issued by Medical Associates Clinic Health Plan of Wisconsin (parent organization Medical Associates Clinic, P.C.). The contract is classified as a MSA product, which governs how enrollees access care: the product rules govern provider access and cost-sharing for this contract. 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 2 states (IA, WI) and 5 counties, a geography set at the CMS service-area definition level.

The overall CMS Star Rating for this contract is not yet published by CMS. This rating synthesizes 22 individual quality measures spanning 4 CMS domains, including clinical outcomes, patient experience (CAHPS), member complaints and appeals, and plan operations. 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 4 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.