The twenty twenty six Health Plan Rating Scorsheet shows how each plan was scored for NCQA's Health Plan ratings. The Scoresheet features plan identifying information at the top, followed by the columns for the measure level rates, the national all lines of business percentiles, the one through five score as a result of comparing the rate to the percentiles, the measure weights, and the rating score times weight calculation. HEDIS data from measurement year twenty twenty five are used to calculate the percentiles. It is important to note that due to timing, NCQA will use measurement year twenty twenty four CAHPS and HOS data for Medicare twenty twenty six ratings. The score sheet ends with the Accreditation Bonus Points and Overall Rating Score calculations. The measures displayed correlate to the measures used in the Health Plan Ratings measure list. The rate is what the plan submitted to NCQA. Please note: The raceethnicity diversity of membership and language diversity of membership measures are scored on a creditno credit scale, where credit transfers into a measure score of five and no credit transfers into a measure score of zero. Risk adjusted utilization measures are scored on a three point scale instead of the standard five point rating scale. Please refer to the Health Plan Ratings Methodology document for further details pertaining to these measures and their unique scoring rules. Taking the submitted rate and comparing it to the national percentiles produces a one to five score. Each measure is given a weight, patient experience measures have a weight of one point five, HEDIS process measures have a weight of one, and HEDIS Outcome Measures have a weight of three. As a reminder, the measure weights for measures with NA and NB audit results do not contribute to the sum of measure weights. However, the measure weights for measures with an audit result of NR, BR, and NQ are included in the sum of measure weights and these measures are given a measure score of zero. If a plan has an accredited or provisional status for NCQA's health plan accreditation as of the last business day in June of the release year, then it is given zero point five bonus points for their achievement. If a plan has an interim accreditation status, then it is given zero point one five bonus points. To calculate the overall rating score, NCQA takes the sum of the measure rating scores multiplied by the scorable measure weights and divides that number by the sum of the scorable measure weights to get the weighted average of the measure ratings. NCQA then adds the accreditation bonus points, if applicable, and truncates the result to three decimal places. This is a plan's unrounded overall score. NCQA then rounds this number to one decimal place according to the methodology. This rounded number is the overall star rating score that is publicly reported in September.
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2026 Health Plan Ratings: The Scoresheet & Methodology
NCQA’s Health Plan Ratings scoresheet video provides a detailed overview of how NCQA evaluates plan performance using the weighted average of a plan’s HEDIS®, CAHPS® and HOS (Medicare only) measure ratings, along with Accreditation bonus points (if the plan is NCQA-Accredited). Scores are calculated on a 0-5 scale in half-point increments, with 5 being the highest score. Final Ratings are published publicly on the NCQA Health Plan Report Card on September 15.