NCQA Health Insurance Plan Ratings – Valuable Tool for Consumers

More than 1,000 health plans are rated based on performance and
quality of care

WASHINGTON–(BUSINESS WIRE)–As millions of Americans consider which health insurance plan fits their
health needs, a new ratings system created by the National Committee for
Quality Assurance (NCQA) provides shoppers with a more accurate picture
of how health plans perform in key quality areas.

Health Insurance Plan Ratings 2015–2016
compare the quality and
services of more than 1,000 health plans that collectively cover 138
million people—over 43% of the US population.

NCQA studied 1,358 health plans and rated 1,016: 491 private
(commercial), 376 Medicare and 149 Medicaid. Click
to Tweet

The ratings give unprecedented importance to health outcomes and
consumer satisfaction.

Advantages of Ratings

  • Simple, User-Friendly Scale: The NCQA ratings blend dozens of
    quality indicators for health plans into a simple scale from 1–5,
    where 1 indicates lower performance and 5 indicates higher performance.

By grouping plans into a few broad categories, the ratings give
consumers a practical, meaningful guide to understanding their health
care choices at a level of detail they choose.

  • Details on Demand: Consumers can “drill down” into any part of
    the ratings to learn how a health plan handles particular health
    issues or patient populations.

For example, expectant parents may be interested in performance on two
measures of prenatal and postpartum care. Families may be interested in
quality results on 10 measures of pediatric preventive care and
treatment, ranging from well-child care for infants to monitoring ADHD
treatment of 12-year-olds.

  • Consistency With Medicare: The NCQA ratings align with the
    Medicare Star Ratings, the influential federal assessment of Medicare
    Advantage health plans. Medicare Advantage plans cover 16.8 million
    Americans—a 51% increase since 2010.

Ratings Focus on Satisfaction & Outcomes

The ratings consist of three major performance categories: consumer
satisfaction, prevention and treatment.

  • Consumer Satisfaction: What patients say about their health
    plans in satisfaction surveys, including about claims processing and
    customer service.
  • Prevention: Check-ups, tests and other care that keeps
    people—especially children—healthy.
  • Treatment: How consistently a plan provides scientifically
    recommended care for common, costly conditions such as diabetes,
    depression and heart disease.

In each category, the results—outcomes—of a patient’s care count extra
in the scoring; for example, whether blood pressure and diabetics’ blood
sugar are controlled to safe, recommended levels.

This emphasis on results means that, together with consumer
satisfaction, outcomes are the main driver of ratings results.

The NCQA-Consumer Reports relationship continues. The Consumer Reports
Web site and the November edition of Consumer Reports magazine
will mention the NCQA ratings and urge readers to examine them at

About NCQA

NCQA is a private, non-profit organization dedicated to improving health
care quality. NCQA accredits and certifies a wide range of health care
organizations. It also recognizes clinicians and practices in key areas
of performance. NCQA’s Healthcare Effectiveness Data and Information Set
(HEDIS®) is the most widely used performance measurement tool
in health care. NCQA’s Web site ( contains information to help
consumers, employers and others make more informed health care choices.


National Committee for Quality Assurance
Andy Reynolds,
Brock, 202-955-1739