In its annual health plan ratings, the National Committee for Quality Assurance (NCQA) found that 11 out of 998 rated plans earning top marks, more than double last year’s total.
Of the 11 plans to achieved a 5-star rating, eight were commercial plans and three were Medicare plans. They included Blue Cross and Blue Shield of Massachusetts, UPMC Health Plan and several Kaiser Foundation Health Plans. An additional 55 plans earned a 4.5-star rating. Most plans ranked between 3 and 4 stars, same as in 2024. The NCQA says its ratings help consumers and regulators assess the quality and effectiveness of health plans.
The report found year-over-year improvements in coordination and continuity of care in Medicare. The NCQA also identified progress across nearly all six diabetes-related measures. The Kidney Health Evaluation for Patients with Diabetes metric showed an average increase of over 5% across all product lines.
Additionally, the NCQA found improved adult and adolescent immunization rates. Though childhood immunization rates continued to decline, they did so at a slower pace than last year.
“NCQA Health Plan Ratings are a vital benchmark for transparency, accountability and consumer choice,” NCQA President Margaret E. O’Kane said in a press release. “By spotlighting health plan performance, we help people and employers make informed choices about the partners in their care, while motivating plans to advance quality and member experience across the health care system.”
Health plans are rated on a scale of 0 to 5 stars based on nearly 50 measures of clinical performance and patient experience. The highest ratings go to health plans that exemplify high-quality care, excellent clinical results, strong member satisfaction and improved health outcomes. Ratings evaluate commercial, Medicare Advantage and Medicaid plans.
This year, the NCQA introduced a new measure in its scoring framework: the Language Diversity of Membership metric. This aims to evaluate whether plans actively identify and collect data on members’ preferred spoken and written languages. The goal is to identify communication gaps and guide quality improvement initiatives to ensure all members get good care.
Some of the data the NCQA uses are from HEDIS and the Centers for Medicare & Medicaid Services’ Health Outcomes Surveys; Consumer Assessment of Healthcare Providers and Systems surveys; and the NCQA’s Health Plan Accreditation. The NCQA is a private nonprofit focused on improving healthcare quality, accrediting and certifying a range of healthcare organizations.