NCQA’s Health Plan Ratings Help Consumers Choose a Health Plan
September 17, 2024 · NCQA Communications
NCQA’s 2024 Health Plan Ratings are here—just in time for open enrollment! Ratings give businesses and consumers a user-friendly tool for comparing and choosing a health plan. This year, 1,019 commercial, Medicare and Medicaid health plans earned a rating from NCQA.
The 2024 Ratings are based on data from calendar year 2023, when approximately 227 million people were enrolled in health plans that reported Healthcare Effectiveness Data and Information Set (HEDIS®) results to NCQA.
How Ratings Work
Health plans are rated on a scale of 1–5 stars. NCQA considers plans with 4.5 and 5 stars as the highest-rated health plans in the nation. Ratings are based on three types of quality measures:
- Measures of clinical quality from HEDIS and the Health Outcomes Survey (HOS).
- Measures of patient experience using the Consumer Assessment of Healthcare Providers and Systems (CAHPS®).
- Results from NCQA’s review of a health plan’s structure and quality processes (NCQA Health Plan Accreditation).
The overall rating is the weighted average of a plan’s HEDIS, CAHPS and HOS measure ratings, plus Accreditation bonus points, if the plan is Accredited by NCQA. Learn more about the Ratings methodology here.
What’s New for 2024?
As part of our commitment to improve health equity through all NCQA products and programs, we increased the scoring threshold for the Race/Ethnicity Diversity of Membership (RDM) measure and increased the measure weight from 0.5 to 1.0. This measure evaluates whether health plans collect information about their members’ race and ethnicity, so they can provide appropriate services.
We also updated the measures included in the 2024 Ratings. You can view a list of the changes here.
Highlights and Results
Here are some key takeaways from our analysis of the Health Plan Ratings data:
Increase in Highly Rated Plans
- Three commercial and two Medicare plans earned a 5-star rating—a slight increase from last year.
- There was a slight increase in Medicare and Medicaid plans that achieved 4- and 4.5-star ratings, demonstrating improvement across several health quality measures.
Improvement in Care Delivery
- Diabetes care improved across all product lines—notably, blood pressure control, HbA1c control and kidney health evaluation.
- Medicare plans got better at coordinating care for older adults who were hospitalized, and showed improvement in medication reconciliation.
- Testing for pharyngitis (sore throat) to determine whether antibiotics should be prescribed improved across all product lines.
Trends to Watch
- Childhood immunization rates declined for commercial and Medicaid plans—a concerning trend we need to watch.
How Consumers Can Use the Ratings
NCQA presents Ratings in a user-friendly online report card to help people choose the best health plan for their needs. Users can:
- Search for a specific health plan by name.
- Filter health plans based on criteria, such as star rating or location, and compare results across multiple plans.
- Drill into the details to find out how well a plan performed on a specific health topic, like cancer screening or diabetes care.
View the 2024 Health Plan Ratings here.
Additional Resources for Health Plans
NCQA provides a guide to help health plans understand and use the Ratings, in addition to key resources:
- Advertising and Publicity Guidelines
- Scoresheet Instructional Video
- Frequently Asked Questions About Health Plan Ratings vs. CMS Star Ratings
Health plans should also be aware that NCQA discontinued the Electronic Clinical Data Distinction in our Health Plan Report Cards. Learn more about that change here.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
