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Help Guide – Before You Select a Health Plan – Three Steps (READ ME)

1. Compare the health insurance plans you are interested in by visiting the NCQA website to see if they are accredited, and how their quality scores compare. 2. Visit at least one of the state-specific reports to find out what the rate of complaints is for the health plan you’re interested in, what hospitals it uses, and information about quality measures. Note: Every state or regional report may be different. If your state is not listed here, see what other states make available. Even if it’s not online, the data probably are collected by your state. 3. See what physicians say about working with certain health plans (link above)

NCQA Health Insurance Plan Ratings and Report Card 2018 Editor's Pick

Compare quality ratings for HMOs and PPO health insurance plans. Aetna, Anthem Blue Cross, Cigna, Humana, Kaiser, United Healthcare – they’re all here, as are many non-profit regional plans. Star ratings and number of enrollees shown for accredited commercial, Medicare and Medicaid plans. NCQA (National Committee for Quality Assurance) is a private nonprofit organization that sets standards for quality of care and service that health plans provide to their members. NCQA Accreditation is a nationally recognized seal of approval. Updated 2018

Link to Your State Insurance Department Site (all states)

If you like to browse, your state’s site may have additional information about health insurance. These links are provided by the National Association of Insurance Commissioners (NAIC), the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC site has a Consumer Information Source to find medical loss ratios, financial information, and complaint information on the exchange, HMOs and other health insurance providers

California – 2017-18 HMO, PPO, & Medical Group Ratings Report Card Editor's Pick

Compare 10 largest California HMO health insurance plans: Aetna Health, Anthem Blue Cross HMO, Blue Shield, Cigna, Health Net, Kaiser Permanente Northern and Southern CA regions, Sharp, United Healthcare and Western Health Advantage. Compare 6 PPOs: Aetna, Anthem Blue Cross, Blue Shield, Cigna, Health Net Life Insurance Company, United Healthcare. Clear, simple star system (4 stars = excellent; 3 stars = good, 2 stars = fair; 1 star = poor) used for overall rating. Actual performance scores are not given, but may be available through NCQA. Quality measures (based on HEDIS scores) for asthma, cancer screening, child health, chlamydia screening, diabetes, heart care, maternity care, behavioral and mental health, and other expected care. Member satisfaction stars also shown. Complaint rates reported for health plans in a separate report. More than 200 Medical Group ratings also provided by county for the larger groups of doctors. Prepared by the California state Office of the Patient Advocate (OPA), published October 2017

Florida Health Insurance Plans – Quality Ratings & Satisfaction Editor's Pick

Member Satisfaction and quality ratings for cancer screening, diabetes, prenatal care, well child care, children’s dental care, high blood pressure for HMOs, Medicare HMOs and Medicaid. Aetna, Amerigroup, AvMed, Better Health, Capital, CIGNA, Clear Health Alliance, Community, Coventry, Florida Health Care, Freedom Health, Health First, Humana, Magellan, Molina, Neighborhood, Positive, Prestige, Simply, Staywell, Sunshine, United Healthcare, Children’s Medical Services and others. Data reflect services received in 2016. Search by county. Additional member satisfaction for PPOs including Florida Blue, Golden Rule, Aetna, Cigna, Humana, United. Easy to read.

Georgia Health Insurance Plan Ratings and Comparisons 2017

Scroll to the bottom to find External Quality Review Organization (EQRO) which lets consumers read about performance of health plans in GA.  Very difficult to navigate. Compare quality ratings and member satisfaction scores for Medicaid, Amerigroup Community Care, Peach State Health Plan, WellCare of Georgia and The Georgia Families 360. Covers access to care, dental visits, ADHD medications, ER visits, diabetes care, prenatal care, 7-day followup after mental health admission, member opinions and more using 2015-2016 scores. Other reports are at this website that may have more information. Released by Georgia Dept. of Community Health at dch.georgia.gov

Illinois HMO and Health Insurance Complaints 2016 by Consumers (pdf)

Click on Consumer Complaint Reports and select Complaint Ratio Reports to find rate of complaints for health insurance companies.  HMO complaints are separate from Individual plans and Group health plan complaints. Worst complaint ratio for 2016 was Aetna HMO; best HMO complaint record was Health Care Service Corporation (Blue Cross Blue Shield of IL). Complaint record from 2016, supplied by the Illinois Dept. of Insurance. Other HMOs include Celtic, Coventry, Health Alliance, Humana, United Healthcare (IL and Midwest). For Group Health coverage, the worst 2016 complaints per 10,000 policies for plans enrolling at least 100,000 people were UnitedHealthcare Insurance Company of Illinois and Blue Cross Blue Shield of IL. The most common HMO, group and individual plan complaints were about claims handling.

Indiana Health Insurance Complaint Index 2016

Compare complaint rates for Indiana health insurance companies (health carriers). Highest 2016 Complaint Index of the largest 12 companies were for CareSource IN, All Savers Ins Co, MDwise Marketplace Inc, UnitedHealthcare Life Ins Co, and Humana Ins Co. From IN Department of Insurance

Maryland HMO & Health Insurance Plan Ratings 2017

Compare Aetna, CareFirst BlueChoice, CFMI & GHMSI; Cigna, Kaiser Permanente, KPIC, MAMSI, MD-IPA, Optimum Choice and United Healthcare on member satisfaction (CAHPS), getting appointments, flu shots, and many clinical measures of care such as Diabetes, breast cancer screening, behavioral health, well child care. Check both Consumer Ratings & Clinical Ratings. Other Medicaid HealthChoice plans (Amerigroup, JAI, Maryland Physicians Care, Medstar, Priority Partners, University of MD Health Partners) are listed separately. 2017 Performance Report by Maryland Health Care Commission uses 2016 data

Maryland: HealthChoice (Medicaid) Health Plan Ratings

Report Card for Consumers, 2018 in English and Spanish, compares Aetna, Amerigroup Community Care, JAI Medical Systems, Kaiser Permanente, Maryland Physicians Care, Medstar Family Choice, Priority Partners, United Healthcare and University of Maryland Health Partners. One health plan(JAI) gets 3 stars (the best) almost across the board. Click on Consumer MCO Report, updated March 2018

Minnesota HMO and Health Insurance Plan Ratings

Quality (HEDIS scores) for HMOs show various quality ratings for 2016, but report for each health plan is 126 pages. No side-by-side comparisons available, nor average scores to make it more user friendly. (See NCQA instead). Financial data and enrollment reports also linked. Compare health insurance plan performance for Blue Plus, HealthPartners Group Health (combined), Gundersen, Itasca Medical Care, Medica, Hennepin Health, PreferredOne, Prime West, Sanford, South Country Health Alliance, and UCare. Site by MN Dept. of Health, December 2017

New Jersey 2016 HMO Performance Report – Compare plans

Compare six health insurance companies (HMO/POS and PPO/EPO) from Aetna, AmeriHealth, CIGNA, Horizon, Oxford and United, on quality ratings related to asthma, COPD, cancer screening, heart care, hypertension, diabetes, new moms, immunizations, mental health; frequency of imaging tests for lower back pain, cardiac cath and tonsillectomies; well child care, more. Easy to read; fast response. Pub. by NJ Dept. of Banking and Insurance, May 2017

New York State HMO Comparisons (Ratings) Editor's Pick

Compare over 20 HMO, PPO or Medicaid managed health insurance plans in NY: Aetna, Affinity, Amida, CDPHP, CIGNA, Empire Blue Cross Blue Shield, Excellus, Fidelis, GHI or HIP (EmblemHealth), HealthNow, Healthfirst, Hudson, Independent Health, MVP, MetroPlus, Oxford, Total Care, UnitedHealthcare, Univera, VNSNY State, WellCare, YourCare. Topics include member satisfaction, opinions about access, cardiovascular care, diabetes care, mental health, maternal health & much more. Actual scores shown on the statewide report. Regional reports show general star level. Consumers can sort the health plans by highest overall performance. Prepared by the state of New York for 2017, using 2016 member data. health.ny.gov

Rhode Island – Top Ratings for Health Insurance Plans (NCQA)

Tufts Associated HMO plan earned the top 5.0 rating from NCQA. Based on Quality, Member Satisfaction and accreditation results. 2017-2018 Ratings

South Carolina Medicaid Health Insurance Plan Ratings 2013

Compare SC Medicaid health plan ratings (one to five stars) for Absolute Total Care, Blue Choice, Select Health, Advicare Corp, Molina HealthCare and WellCare of SC, for 2013. Many performance scores for Fee for Service Total and Overall State scores are just one-star (the lowest). Scores reported for Pediatric Care, Adolescents, Women’s Care (e.g. cancer screening, prenatal and postpartum), Living with diabetes or asthma, Behavioral Health and follow-up after hospitalization for mental illness, Access to Primary Care, consumer member satisfaction and more. South Carolina Health Data (schealthviz), Sept. 2014 report is the latest available as of April 2018.

Texas – Compare Texas HMOs 2017 – Consumer Ratings (OPIC)

Texas consumer ratings of their health insurance plans & care. Compare HMO plans for Central Texas, East Texas, Gulf Coast, North TX, Panhandle/Plains area, South Texas, West Texas regions. Satisfaction ratings, complaints and market share shown for Humana, Aetna Health, Allegian, FIRSTCARE, Scott and White Health Plan, Sendero, Community First, HMO Blue Texas, Molina, Cigna, United Healthcare and Community Health Choice. Shows 2016-2017 complaint rates. Both provider and patient complaints are recorded, with consumers complaining much more frequently than providers. Highest consumer complaints (17 per 10,000 enrollees) were about Aetna Health. Highest provider complaints (2 per 10,000 enrollees) were about UnitedHealthcare of Texas. Report by Texas OPIC (Office of Public Insurance Counsel)

Texas – Guide to Texas HMO Quality 2017 (OPIC)

Lengthy (270 pages) but valuable report showing detailed clinical quality comparisons between HMO health insurance plans for indicators such as asthma, childhood immunizations, cancer screening, heart care, high blood pressure, diabetes care, prenatal care, mental health care, flu shots, antibiotic utilization rates, rates of physician board certification, and more. Compare HMOs Aetna, Allegian, Cigna, Community First, Community Health Choice, FIRSTCARE, HMO Blue Texas, Humana, Molina, Scott and White, Superior and United Healthcare of Texas. Pub. by TX Office of Public Insurance Council

Utah HMO Health Insurance Plan 2017 Ratings

Compare Utah HMOs – health insurance plans Aetna, Altius, Cigna, Deseret, Educators Mutual EMI, Humana, PEHP, Regence Blue Cross BS, SelectHealth, Tall Tree, United Healthcare, and Medicaid plans (Healthy U, Molina, SelectHealth CHIP, Utah FFS) on member satisfaction, antidepressant medications, back pain, cancer screening, and high blood pressure; diabetes, prenatal & maternity, preventive care, well-child visits & immunizations, and more. Shows actual performance rates. 2017 Performance Report published by utah.gov using 2016 data

Utah Member Satisfaction Ratings with Health Insurance Plans (CAHPS)

Scroll to see Adult and Child Results in separate reports. 2016 data shown in Consumer Satisfaction Report (CAHPS) from Utah Department of Health Office of Health Care Statistics. Measures satisfaction with health plan, doctor, communication, quality of care, how quickly you can get an appointment, and more. Updated January 2018

Vermont – Compare Health Insurance Plan Ratings 2014 (pdf)

Compare Blue Cross Blue Shield of VT (Health Partnership and Freedom Plan), CIGNA, MVP, and The Vermont Health Plan BlueCare on consumer and patient experiences; how well the plans do cancer screening, flu shot and other immunizations, antibiotic use in kids, prenatal care, asthma & bronchitis care, mental health treatment, back pain evaluation, alcohol dependence and COPD care. State report December 2014 by Dept. of Banking, Insurance uses 2014 CAHPS and 2013 HEDIS data; 4 pages. No updates available for 2018.

Virginia – Compare HMOs (Quality and Satisfaction) Editor's Pick

Easy to use tool to compare insurance plan ratings: Aetna, CareFirst BlueChoice, HealthKeepers (Peninsula & Priority), Innovation Health Plan, Kaiser Mid-Atlantic, Optima, Optimum Choice, United Healthcare MidAtlantic and River Valley. Choose measures for access, asthma, ADHD, heart, diabetes, arthritis, immunizations, medications, mental health care (best plan for 7-day follow-up is Kaiser at 70%, compared to HealthKeepers e.g. at just 47%), preventive care, spirometry for COPD, prenatal, maternity and newborn care; weight assessment, well child visits and childhood illnesses, member satisfaction for 2016 and more. Also includes Board certification rates for some types of physicians, number of enrollees, and financial data. Of note, the largest plan HealthKeepers, was also the lowest rated in member satisfaction.

WA Clinic and Health Plan Quality Ratings (WACommunityCheckup.org)

Compare care among 300 medical groups in Washington state. Scroll to Medical Group Performance to see medical group rankings beginning on Figure 18. Highest rated for 2017 were Kaiser Permanente Washington and Virginia Mason for Commercially insured patients; Kaiser and Swedish Medical Centers were highest for Medicaid patients. Groups include Pacific Medical Centers, The Everett Clinic, The Polyclinic, UW Medicine, Columbia Medical Associates, Family Care Network, Women’s Healthcare Alliance, Northwest Physicians Network, MultiCare and International Community and hundreds of others. For two measures, 10 health insurance plans and 9 accountable communities of health (ACOs) were compared. Community Checkup by Washington Health Alliance, uses 2015-2016 data, pub. December 2017

Washington – Health Insurance Plan Complaint Index 2016

Compare complaint levels for WA health insurance plans (2016 Health Carrier Complaints) for Kaiser Northwest, Options, Coordinated Care, Delta Dental, Kaiser, UnitedHealthcare, Regence BlueShield, Regence Blue Cross, Premera Blue Cross, Moda, Lifewise, Modina, Asuris Northwest, Bridgespan Health and more. Market share also shown. State Office of Insurance Commissioner OIC

Wisconsin – HMO Health Plan Quality and Consumer Satisfaction Graphs

View graphs comparing rates for breast cancer screening, cervical cancer screening, diabetes care / eye exams, follow-up for mental illness, time spent with physician, children’s visits to primary care providers, and overall rating of health insurance plans: Dean, Group Health Coop, Gundersen Lutheran, Humana, Medical Associates, Medica, MercyCare HMO, Network, Physicians Plus, UnitedHealthcare, Unity, WPS and more. 2015 data, updated January 2017 by State of WI, OCI

Other Helpful Listings

Accredited Ambulatory Health Care and Surgery Centers (AAAHC)

The nonprofit Accreditation Association for Ambulatory Health Care (AAAHC) currently accredits over 6000 organizations in a wide variety of ambulatory health care settings, including ambulatory and office based outpatient surgery centers, community health centers, endoscopy centers, lithotripsy centers, some managed health plans, medical group practices, retail clinics, urgent care centers, specialty services, and workplace clinics.  (See also Joint Commission site for hospital-owned ambulatory surgery center accreditation.)

Government Employee Health Insurance Cost Comparisons (FEHB)

Web site from US Office of Personnel Management (OPM) helps federal employees and others compare the benefits, member satisfaction, and employee costs of up to 4 health insurance plans at one time. Search by zip code; choose local plans and/or national plans. Convenient and current. The amount that taxpayers and government institutions pay toward the total health care premiums is no longer readily available

URAC – searchable database

URAC is a nonprofit organization that performs accreditation and certification work. Its many accreditation programs include, among others, Case Management, Comprehensive Wellness, Health Call Centers, Health (clinical information) Web Sites, Health Utilization Management and Review, and Workers Compensation Management. This site may help employers determine which companies they want to consider as service providers. In addition, a few health insurance plans have also sought health plan accreditation from URAC

Wisconsin Health Insurance Cost Rankings 2018

Annual premiums and deductibles (2018) for employee health insurance in various metro markets averaged $10,043 per year for single coverage. Citizen Action of Wisconsin, a coalition of individuals and organizations (such as AFSCME locals, AFL-CIO, WEAC, WI Farmers Union), reports health insurance cost in 18 metro regions, including Twin Cities. Rates in Eau Claire ($10,908 per yr, single) were 20% higher than Madison rates ($9096 per yr.) Most areas exceeded $10,00 single. Health plan costs shown for Twin Cities, Oshkosh, Green Bay, Appleton, Manitowoc, Sheboygan, Fond du Lac, Janesville/Beloit, Wausau, Stevens Point, La Crosse, Superior, Eau Claire, Kenosha, Racine, Milwaukee, Dubuque, more. Uniform benefits package was used for all areas, however the report does not specify what type of benefits and deductibles were included. The report also does not indicate whether the rates were adjusted for regional differences in age, or healthy behaviors. Shows annual inflation pre-ACA (2000 to 2013) compared to after ACA (2014-2018), with post-ACA so very much lower. However, this summary can be misleading. In 2018, large group rates went down 5%, while individual inflation was up 51% (up 60% in Madison, doubled in Green Bay), and small group inflation was 10% compared to 2017. Large Group information reflects government employee rate paid by State of Wisconsin’s Group Health Insurance Program (GHIP)

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