Contract
H5594
Optimum HealthCare, Inc. · 2027 Star Ratings
OPTIMUM HEALTHCARE, INC. · Local CCP · offers special needs plans
Parent: Elevance Health, Inc.
Summary ratings
Overall
4.5
2026: 4.5±0
Part C · health plan
4.5
2026: 4.5±0
Part D · drug plan
3.5
2026: 4.0−0.5
2027 footprint
- Members, Sep 2026
- 80K
- 2027 plans
- 13
- Open to all ($0 premium)
- 6 (6)
- Counties
- 24
- Special needs plans
- Chronic or Disabling Condition, Dual-Eligible
- Drug coverage
- Yes
FL
Domain stars
| Domain | 2027 | 2026 | Change |
|---|---|---|---|
| HD1Staying Healthy: Screenings, Tests and Vaccines | 4.0 | 4.0 | ±0 |
| HD2Managing Chronic (Long Term) Conditions | 4.0 | 4.0 | ±0 |
| HD3Member Experience with Health Plan | 4.0 | 4.0 | ±0 |
| HD4Member Complaints and Changes in the Health Plan's Performance | 4.0 | 4.0 | ±0 |
| HD5Health Plan Customer Service | 5.0 | 5.0 | ±0 |
| DD1Drug Plan Customer Service | 5.0 | 5.0 | ±0 |
| DD2Member Complaints and Changes in the Drug Plan's Performance | 3.0 | 4.0 | −1.0 |
| DD3Member Experience with the Drug Plan | 5.0 | 5.0 | ±0 |
| DD4Drug Safety and Accuracy of Drug Pricing | 3.0 | 4.0 | −1.0 |
Part C measures · health plan
| Measure | 2027 result | 2027 stars | vs 2026 |
|---|---|---|---|
| C01Breast Cancer Screening | 83% | 5.0 | ±0 |
| C02Colorectal Cancer Screening | 83% | 5.0 | new spec |
| C03Annual Flu Vaccine | 58% | 2.0 | −1 |
| C04Improving or Maintaining Physical Health | 72% | 3.0 | ±0 |
| C05Improving or Maintaining Mental Health | 87% | 4.0 | ±0 |
| C06Monitoring Physical Activity | 55% | 4.0 | ±0 |
| C07Special Needs Plan (SNP) Care Management | 92% | 5.0 | ±0 |
| C08Care for Older Adults – Medication Review | 100% | 5.0 | ±0 |
| C09Care for Older Adults - Functional Status Assessment | 99% | 5.0 | — |
| C10Osteoporosis Management in Women who had a Fracture | 77% | 5.0 | ±0 |
| C11Diabetes Care – Eye Exam | 84% | 4.0 | ±0 |
| C12Diabetes Care – Blood Sugar Controlled | 92% | 5.0 | +1 |
| C13Kidney Health Evaluation for Patients with Diabetes | 91% | 5.0 | ±0 |
| C14Controlling High Blood Pressure | 94% | 5.0 | ±0 |
| C15Reducing the Risk of Falling | 63% | 4.0 | ±0 |
| C16Improving Bladder Control | 54% | 5.0 | ±0 |
| C17Plan All-Cause Readmissions | 10% | 4.0 | +1 |
| C18Statin Therapy for Patients with Cardiovascular Disease | 86% | 3.0 | ±0 |
| C19Transitions of Care | 69% | 4.0 | +1 |
| C20Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions | 71% | 3.0 | −2 |
| C21Getting Needed Care | 86 | 5.0 | ±0 |
| C22Getting Appointments and Care Quickly | 89 | 5.0 | ±0 |
| C23Customer Service | 91 | 4.0 | +1 |
| C24Rating of Health Care Quality | 87 | 4.0 | ±0 |
| C25Rating of Health Plan | 90 | 5.0 | ±0 |
| C26Care Coordination | 87 | 3.0 | −1 |
| C27Complaints about the Health Plan | 0.19 | 4.0 | −1 |
| C28Members Choosing to Leave the Plan | 16% | 4.0 | ±0 |
| C29Health Plan Quality Improvement | Medicare shows only a Star Rating for this topic | 4.0 | +1 |
| C30Plan Makes Timely Decisions about Appeals | 99% | 4.0 | ±0 |
| C31Reviewing Appeals Decisions | 100% | 5.0 | ±0 |
| C32Call Center – Foreign Language Interpreter and TTY Availability | 100% | 5.0 | ±0 |
Part D measures · drug plan
| Measure | 2027 result | 2027 stars | vs 2026 |
|---|---|---|---|
| D01Call Center – Foreign Language Interpreter and TTY Availability | 100% | 5.0 | ±0 |
| D02Complaints about the Drug Plan | 0.19 | 4.0 | −1 |
| D03Members Choosing to Leave the Plan | 16% | 4.0 | ±0 |
| D04Drug Plan Quality Improvement | Medicare shows only a Star Rating for this topic | 2.0 | −1 |
| D05Rating of Drug Plan | 91 | 5.0 | ±0 |
| D06Getting Needed Prescription Drugs | 91 | 4.0 | ±0 |
| D07MPF Price Accuracy | 99 | 4.0 | −1 |
| D08Medication Adherence for Diabetes Medications | 89% | 3.0 | −1 |
| D09Medication Adherence for Hypertension (RAS antagonists) | 90% | 4.0 | ±0 |
| D10Medication Adherence for Cholesterol (Statins) | 89% | 3.0 | ±0 |
| D11Statin Use in Persons with Diabetes (SUPD) | 92% | 4.0 | ±0 |
| D12Concurrent Use of Opioids and Benzodiazepines (COB) | 17% | 2.0 | — |
| D13Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH) | 9% | 3.0 | — |
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