Look Up Your Plan in NCQA’s Health Insurance Ratings

September 23, 2015 · Shireesha Jevaji

A chat with a friend made it clear to me how smart people don’t always know about the resources available when they make health insurance decisions. My friend was not at all satisfied with her recent visit to a doctor she found through her health insurance plan. My friend is unfamiliar with the complexities of the health care universe—like many other people—and sometimes makes decisions “in the dark.”

Our conversation presented an opportunity to talk about the efforts of the National Committee for Quality Assurance (NCQA) to reach past plans and providers—to the patient—with a tool that could prevent an experience like hers.

NCQA Health Insurance Ratings

As many health care insiders know, every year, NCQA rates health insurance plans. The latest results were released last week. See the official press release.

Health insurance ratings always attract attention from health care insiders, industry leaders and media. But the ratings are really about helping consumers choose a plan that meets their needs for quality and value.

My friend can do a little bit of homework that can make a big difference. She can look for her plan—and perhaps a few alternatives—on the NCQA Health Insurance Ratings. Each is rated on a simple, user-friendly scale of 1–5, in half-point increments. Scores are determined through a formula that considers customer satisfaction surveys, quality of care measures and accreditation data. My friend can even “drill down” for detailed information about how a health plan handles specific health issues or patient populations.

The 2015–2016 ratings compare quality and services of more than 1,000 health plans that collectively cover 138 million people—almost half the US population. NCQA studied more than 1,358 HMOs and PPOs and rated 491 private (commercial) plans, 376 Medicare plans and 149 Medicaid plans on performance measure and consumer satisfaction scores.

The ratings are a lot of complex data simplified, but substantive. They can be valuable for consumers like my friend—people outside the health care universe—if consumers know they are available. Consider telling your friends about it. Share this link. They’ll get an “apples-to-apples” comparison of health insurance plans—and perhaps they’ll avoid a lemon.

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