RESOURCES FOR HEALTH PLANS
NCQA’s 2023 Health Plan Ratings include commercial, Medicare and Medicaid health plans. The overall rating is the weighted average of a plan’s HEDIS® and CAHPS® measure ratings, plus bonus points for plans with a current Accreditation status as of June 30, 2023.
The 2023 Ratings were released electronically on September 15, 2023—Consumers used this valuable information when they chose health plans during open enrollment.
- 2023 Health Plan Ratings in Excel Format (Internal Use Only).
- 2023 Health Plan Ratings Scoresheets: 2023 Final Ratings and scoresheets for plans (for internal quality improvement efforts only).
- 2023 Methodology: How we calculate the ratings (updated August 22, 2023).
- 2023 Measure List: A list of required Performance Measures (updated July 26, 2023).
- Advertising and Publicity Guidelines: Rules for promoting results.
- Frequently Asked Questions about HPR vs. CMS Star Ratings.
- Medicare Advantage CAHPS Guidance.
- Scoresheet Instructional Video.
- Previous Health Plan Ratings.
2023 Schedule
Plan Confirmation—Early May
- (Action Required) Confirmation of HEDIS/CAHPS submissions and other information used (e.g., organization name, states, Accreditation status) to calculate ratings. Plans have 10 business days to confirm.
HEDIS and CAHPS Submission—June 15
- This submission deadline is defined in the HEDIS Volume 2 Technical Specifications.
Projected Ratings—Early August (Action Required)
- All plans (Accredited and non-Accredited) must review their information on the Projected Ratings site within 10 business days in order for NCQA to complete the review process. There are four possible rating options:
- Numeric Score: The plan submitted both HEDIS and CAHPS data for public reporting (regardless of its Accreditation status), and is assigned a score from 0–5 in .5 increments.
- Partial Data Reported: More than 50% of the weight of the plan’s submitted measures are “NA” or “NB”; or the plan submitted HEDIS data but did not submit CAHPS data (or vice versa); or the plan did not have a numerical rating (1–5) on at least one subcomposite (e.g., Getting Care, Cancer Screening) under all three composites (Patient Experience, Prevention and equity, Treatment); or the plan earned an NCQA Accreditation status that does not require HEDIS, and did not submit HEDIS or opted not to publicly report data.
- No Data Reported: The plan opted not to report data publicly, or did not report HEDIS or CAHPS information to NCQA and does not have an Accreditation status of Accredited, Interim or Provisional.
- Low Enrollment: The plan did not submit data, or opted not to report data publicly and had fewer than 15,000 enrollees. These plans are omitted and are not listed in the public display of Ratings on the NCQA Health Plan Report Card in September.
Final Ratings—Late August/Early September
- A private release of final ratings to all plans.
NCQA Releases Ratings—On or around September 15
- Final ratings posted on the NCQA Health Plan Report Card.
- Embargo on plan rating-related promotions ends at 6pm ET; plans may begin advertising their ratings at this point.
Questions? Contact NCQA’s Health Plan Ratings Help Desk at my.ncqa.org
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