Ranking and Accrediting Health Plans

NCQA Accredits health plans with strong consumer protections and a commitment to quality. NCQA is the only accreditor that rates and publicly reports health plan quality. That helps consumers find the best value. It also creates a powerful incentive for plans to do better. 

To earn NCQA Accreditation, plans must provide essential consumer protections. That includes access to care, accurate marketing materials and clear information on your rights.

NCQA requires plans to measure, report, and improve the quality of clinical care. We look at how well plans provide preventive and chronic care and achieve the best outcomes.  NCQA measures clinical quality with our Healthcare Effectiveness Data and Information Set (HEDIS). 

NCQA requires health plans to measure, report and improve the experience of care. NCQA measures experience of care with the Consumer Assessment of Health Plans Survey (CAHPS).  CAHPS asks real patients like you about their “experience of care.” For example:
  • Did you get care when you needed it?
  • Was customer service staff helpful and polite?
  • Did doctors listen to you and explain things in a way that you could understand? 

NCQA uses HEDIS and CAHPS scores to rank and publicly report on the quality of each health plan. We are the only accreditor that ranks and reports how well each plan does at providing quality. NCQA awards three levels of accreditation – Accredited, Commendable and Excellent – so it is easy for consumers to tell which plans are good, better and best.

NCQA produces report cards that rate plans in ways consumers care about and understand. For example, we rate how well plans help people “Stay Healthy,” “Get Better” when sick and “Live with Illness” that has no cure. Public reporting also encourages plans to improve and provide better value. In fact, Medicare, many employers and other purchasers pay plans based in part on NCQA findings.

For all these reasons, NCQA Health Plan Accreditation is the “Gold Standard.” 

*HEDIS is a registered trademark of NCQA.

 *CAHPS is a registered trademark of the Agency for Healthcare Research and Quality, which oversees the survey.