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H3204 · Presbyterian Health Plan: 2027 Star Rating
H3204 (Presbyterian Health Plan, PRESBYTERIAN HEALTH PLAN) earned 3.0 stars in the 2027 Medicare Advantage Star Ratings, the same as in 2026. Parent company: Presbyterian Healthcare Services. Plan type: Local CCP · offers special needs plans.
2027 overall CMS
3.0
Part C 3.0 · Part D 3.5
2026 overall CMS
3.0
Part C 3.0 · Part D 2.5
Change Calc
Same
2027 vs 2026
Members Calc
52,304
CMS county files, October 2026
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What stands out for H3204
- Most of its members are in New Mexico (52,304, 26.6% of Medicare Advantage members in CMS county files there). Calc
- Of the 11 rated contracts with members in New Mexico, 7 have a higher 2027 rating and 2 have the same rating. Calc
- Largest other contract in New Mexico: H2406 · UnitedHealthcare, 4.0 stars, 39,428 members. Calc
- At 3.0 stars it is below the 4-star line that sets 2028 quality bonus payments. CMS rule
- 9 of its 45 rated measures are at 5 stars; 13 are at 1 or 2 stars. Calc
- Its Part C rating (3.0) is lower than its Part D rating (3.5). CMS
Weakest high-weight measures
Measures with weight 2 or more and the lowest stars. These move the overall rating most.
- Getting Needed Care (C21, weight ×2): 1 star, score 74
- Getting Needed Prescription Drugs (D06, weight ×2): 1 star, score 87
- Improving or Maintaining Physical Health (C04, weight ×3): 2 stars, score 67
- Improving or Maintaining Mental Health (C05, weight ×3): 2 stars, score 82
- Controlling High Blood Pressure (C14, weight ×3): 2 stars, score 75
All 2027 measure scores Sourced: CMS
| Measure | Weight | Score | Stars |
|---|---|---|---|
| Breast Cancer Screening (C01) | ×1 | 75 | 3 |
| Colorectal Cancer Screening (C02) | ×1 | 73 | 3 |
| Annual Flu Vaccine (C03) | ×1 | 74 | 5 |
| Improving or Maintaining Physical Health (C04) | ×3 | 67 | 2 |
| Improving or Maintaining Mental Health (C05) | ×3 | 82 | 2 |
| Monitoring Physical Activity (C06) | ×1 | 47 | 2 |
| Special Needs Plan (SNP) Care Management (C07) | ×1 | 54 | 2 |
| Care for Older Adults - Medication Review (C08) | ×1 | 91 | 3 |
| Care for Older Adults - Functional Status Assessment (C09) | ×1 | 82 | 3 |
| Osteoporosis Management in Women who had a Fracture (C10) | ×1 | 66 | 4 |
| Diabetes Care - Eye Exam (C11) | ×1 | 77 | 3 |
| Diabetes Care - Blood Sugar Controlled (C12) | ×3 | 88 | 3 |
| Kidney Health Evaluation for Patients with Diabetes (C13) | ×1 | 72 | 4 |
| Controlling High Blood Pressure (C14) | ×3 | 75 | 2 |
| Reducing the Risk of Falling (C15) | ×1 | 58 | 3 |
| Improving Bladder Control (C16) | ×1 | 49 | 4 |
| Plan All-Cause Readmissions (C17) | ×3 | 9 | 4 |
| Statin Therapy for Patients with Cardiovascular Disease (C18) | ×1 | 80 | 1 |
| Transitions of Care (C19) | ×1 | 71 | 4 |
| Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions (C20) | ×1 | 55 | 2 |
| Getting Needed Care (C21) | ×2 | 74 | 1 |
| Getting Appointments and Care Quickly (C22) | ×2 | 80 | 2 |
| Customer Service (C23) | ×2 | 90 | 3 |
| Rating of Health Care Quality (C24) | ×2 | 85 | 2 |
| Rating of Health Plan (C25) | ×2 | 87 | 4 |
| Care Coordination (C26) | ×2 | 86 | 3 |
| Complaints about the Health Plan (C27) | ×2 | 0.1 | 5 |
| Members Choosing to Leave the Plan (C28) | ×2 | 5 | 5 |
| Health Plan Quality Improvement (C29) | ×5 | – | 4 |
| Plan Makes Timely Decisions about Appeals (C30) | ×2 | 100 | 5 |
| Reviewing Appeals Decisions (C31) | ×2 | 96 | 3 |
| Call Center - Foreign Language Interpreter and TTY Availability (C32) | ×2 | 98 | 4 |
| Call Center - Foreign Language Interpreter and TTY Availability (D01) | ×2 | 97 | 4 |
| Complaints about the Drug Plan (D02) | ×2 | 0.1 | 5 |
| Members Choosing to Leave the Plan (D03) | ×2 | 5 | 5 |
| Drug Plan Quality Improvement (D04) | ×5 | – | 5 |
| Rating of Drug Plan (D05) | ×2 | 86 | 3 |
| Getting Needed Prescription Drugs (D06) | ×2 | 87 | 1 |
| MPF Price Accuracy (D07) | ×1 | 100 | 5 |
| Medication Adherence for Diabetes Medications (D08) | ×3 | 87 | 2 |
| Medication Adherence for Hypertension (RAS antagonists) (D09) | ×3 | 89 | 3 |
| Medication Adherence for Cholesterol (Statins) (D10) | ×3 | 89 | 3 |
| Statin Use in Persons with Diabetes (SUPD) (D11) | ×1 | 84 | 2 |
| Concurrent Use of Opioids and Benzodiazepines (COB) (D12) | ×1 | 6 | 5 |
| Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH) (D13) | ×1 | 7 | 4 |
Where H3204 has members
New Mexico (52,304)
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Sources: CMS 2027 and 2026 Star Ratings data tables (CMS Part C and D performance data); CMS monthly enrollment by contract and county (October 2026). Sourced: CMS marks figures taken from CMS. Calculated marks figures Carelytics added up or compared. Built 2026-10-25.