EMBLEMHEALTH PLAN, INC.
What the CMS Data Shows About EMBLEMHEALTH PLAN, INC.
EMBLEMHEALTH PLAN, INC. operates under CMS contract H5528, issued by EmblemHealth (parent organization EmblemHealth, Inc.). The contract is classified as a Local PPO product, which governs how enrollees access care: PPO designs let members see out-of-network providers at higher cost-sharing, giving broader access than an HMO. 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 49 states (AL, AR, AZ, CA, CO, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY) and more than 40 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. Individual measure-level data is not published for this contract. 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. Supplemental-benefit detail is not available in the public file for this contract. 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.
Supplemental Benefits
No supplemental benefit data available.
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.
County Availability
Showing 40 of 50 counties. Search by state for full coverage.
Medicare Advantage Guides
Related Healthcare Data
Frequently Asked Questions
What is the star rating for EMBLEMHEALTH PLAN, INC.?
EMBLEMHEALTH PLAN, INC. (Contract H5528) by EmblemHealth has an overall CMS star rating of Not yet rated out of 5. Star ratings are based on quality measures including preventive care, chronic disease management, and member satisfaction.
How much does EMBLEMHEALTH PLAN, INC. cost per month?
EMBLEMHEALTH PLAN, INC. has a monthly premium of data not available. Plan costs may vary by county.
What type of plan is EMBLEMHEALTH PLAN, INC.?
EMBLEMHEALTH PLAN, INC. is a Local PPO Medicare Advantage plan offered by EmblemHealth. This is also a Special Needs Plan (SNP) designed for beneficiaries with specific diseases, characteristics, or care needs. PPO plans offer more provider flexibility, allowing you to see out-of-network providers at a higher cost.
Where is EMBLEMHEALTH PLAN, INC. available?
EMBLEMHEALTH PLAN, INC. is available in 49 states (AL, AR, AZ, CA, CO, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY) across more than 40 counties. Coverage area can vary — check with the insurer or Medicare.gov for exact availability in your ZIP code.
Data Source
Data from CMS Medicare Advantage 2026 Star Ratings and Plan Finder datasets. Contract ID: H5528. Last updated: 2026 plan year.
Read our methodology — how this data is sourced, computed, and verified.