How to determine a quality health plan?

You will want to evaluate several elements of a plan before selecting one, but there are three key things that you can review when choosing a plan to help determine its potential quality.  These include:

  1. Accreditation status.
  2. NCQA Report Card results.
  3. Member survey results.

Accreditation Status

Look for the NCQA Accreditation seal when choosing a health plan. Accreditation helps identify health plans that have important consumer protections and a commitment to quality and value. NCQA is the only accreditor with experience at rating and publicly reporting health plan quality. This information can help you find the best value for the money you pay, and is available at ncqa.org.

Report Card

NCQA’s Health Plan Report Card lets you compare plans, their accreditation status and the level of care they provide. Follow these steps to help you select a plan:

Step 1:  Go to your state’s Marketplace Web site and apply for coverage.

Step 2:  You will see a list of plans you are eligible for. Narrow down this list to a few plans you are considering.

Step 3:  Visit NCQA’s Health Plan Report Card

and search to see if a plan has earned commercial, Medicaid or Marketplace accreditation.

Step 4:  Review the information about the plan.

Step 5:  Select the plan that is the best fit for you!

When you search the NCQA Report Card for your state, select “commercial,” “Medicaid” and “Marketplace” plans to review:

  • Overall Accreditation Status: Plans can earn different levels of accreditation. Plans with higher levels of NCQA Accreditation can generally be expected to provide better care and service than plans with lower levels of accreditation, but any level of NCQA Accreditation indicates a plan’s commitment to quality improvement.

Note: Because some plans were created for the Marketplace and are brand new, they are accredited but will not be awarded all the levels of accreditation until they can be evaluated in action.

  • Star Ratings: In many cases, more than one health plan you compare will have earned the same level of accreditation. In this case, you should consider how each plan’s performance (indicated by the “star” rating) matches factors that are most important to you.

Member Survey Results

Some Marketplaces include information about customer experience that was submitted as part of a health plan’s accreditation. This information is provided through customer feedback and it rates plans in three areas:

  • Overall plan rating: What percentage of the plan’s current members rated the plan a 9 or 10 out of 10?
  • Overall rating of care received: What percentage of the plan’s current members rated the care they get a 9 or 10 out of 10?
  • Ease of getting needed care: What percentage of the plan’s current members said it was easy to get care when they needed it?

Marketplace Resources

Many government and nonprofit organizations provide resources for people who want to learn more about their state’s Health Insurance Marketplace.

  • Healthcare.gov: The official government Web site can help you learn more about the Health Insurance Marketplace.
  • Get Covered America: A nonprofit, third-party Web site with information on the Marketplace and how to purchase health insurance.
  • Kaiser Health News: This non-profit news organization explains what you need to know about the new online marketplaces.
  • WebMD: A for-profit health resources site with information ranging from basic information to understanding costs to how to find your state marketplace.