WELLMARK ADVANTAGE HEALTH PLAN, INC.

What the CMS Data Shows About WELLMARK ADVANTAGE HEALTH PLAN, INC.

WELLMARK ADVANTAGE HEALTH PLAN, INC. operates under CMS contract H8095, issued by Wellmark Advantage Health Plan (parent organization Blue Cross Blue Shield of Michigan Mutual Ins. Co.). 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 2 states (IA, SD) 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. This rating synthesizes 18 individual quality measures spanning 6 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 4.0, 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 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.