Boston Medical Center Health Plan, Inc.

What the CMS Data Shows About Boston Medical Center Health Plan, Inc.

Boston Medical Center Health Plan, Inc. operates under CMS contract H6851, issued by WellSense Health Plan (parent organization BMC Health System, Inc.). 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 (NH) and 10 counties, a geography set at the CMS service-area definition level.

The overall CMS Star Rating for this contract is 3.0 out of 5.0. This rating synthesizes 31 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 3.0, 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 $0 (no premium beyond Part B) and an annual Part D drug deductible of $495.00, from the CMS CY2026 Landscape file; every enrollee also pays the standard Part B premium. Beyond standard Medicare Parts A and B, the contract documents 11 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.