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. Visit the federal Marketplace Exchange (link below), or your state exchange to see what ratings, prices and comparisons exist among the plans you are interested in.
NCQA ratings and report card for 2021 on health insurance plans were canceled this year due to COVID. However, the 2020 ratings are available. 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. Five private commercial plans received the highest possible 5-point star rating: two Capital District Physicians’ plans (CDPHP and CDPHN), Kaiser Foundation Mid-Atlantic States, and two Tufts plans (Tufts Associated HMO and Tufts Benefit Administrators). Thirty-three (33) plans received ratings of 4.5 stars. 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. Presumably, the ratings will be updated next in 2021.
Find individual health insurance plan options and prices at healthcare.gov. This is the ONLY health insurance site to use if you want (and qualify for) the federal subsidies for affordable health insurance AND your state participates in the federal marketplace exchange. Compare plans on monthly premium prices, deductibles, plan features and star quality ratings. The federal marketplace exchange shows Bronze, Silver, Gold and Platinum metal levels. It first opened for 2014. People who don’t get subsidies can also choose a plan and enroll at healthcare.gov. Open enrollment for everybody (except Medicare) between November 1 and December 15, 2020 for 2021. Select Preview Now if you just want to scan the plans before you create an account. At minimum, enter your age, or you may get false prices. If you lose coverage during the year, you may also qualify to enroll outside of the Nov.-Dec. open enrollment. Links are provided to your state marketplace if your state has its own health insurance website. Editor’s Pick.
List of state Insurance Departments for 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, Puerto Rico and the other four 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 plan providers.
Find California HMO, PPO and Medical Group ratings report card for 2020-2021. Both Kaiser Permanente HMO Plan of Southern California and Northern California received the highest ratings for Quality. Sharp Health Plan HMO received the highest ratings for member satisfaction. The lowest rating went to Aetna PPO. Compare 16 largest California HMO health insurance plans: Aetna, Anthem Blue Cross HMO, Blue Shield, Cigna, Health Net, Kaiser Permanente Northern and Southern CA regions, Sharp Health Plan, United Healthcare and Western Health Advantage. Compare 6 of the largest PPOs: Aetna, Anthem Blue Cross, Blue Shield, Cigna, Health Net Life Insurance Company, United Healthcare. Clear, simple star system (5 stars = excellent; 4 stars = very good; 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 are reported for health plans in a separate report. Nearly 200 Medical Group ratings also provided by county for the larger groups of doctors. For example, nearly 60 different Kaiser Permanente medical groups are included; Sutter, Scripps, Sharp and many more. Prepared by the California state Office of the Patient Advocate (OPA).
Find Florida health insurance plans member satisfaction and quality ratings. Topics may vary from year to year. They usually include cancer screening, diabetes, prenatal care, well child care, children’s dental care, high blood pressure for HMOs, Medicare HMOs and Medicaid. Aetna, AvMed, Better Health, Capital, CIGNA, Clear Health Alliance, Community, Coventry, Florida Health Care, Freedom Health, Health First, Health Options, Humana, Molina, Neighborhood, Positive, Prestige, Simply, Staywell, Sunshine, United Healthcare, Children’s Medical Services and others. Search by county. Member satisfaction for Aetna, AvMed, Capital Health Plan HMO (highest member satisfaction), Cigna, Coventry, Florida Blue, Florida Health Care Plan, Golden Rule PPO (lowest member satisfaction), Health First, Humana, Molina, Neighborhood, Sunshine Health, United. Easy to read. Choose stars or actual ratings. FL reports from floridahealthfinder.gov.
Find Georgia health insurance plan ratings and comparisons for 2020. Scroll to the bottom to find External Quality Review Organization (EQRO) which lets consumers read about performance of health plans in GA. Large report using HEDIS measures. Compare quality ratings and member satisfaction scores for Medicaid, Amerigroup, including 360 (Anthem), CareSource, Peach State Health Plan, and WellCare of Georgia. Covers access to care, cancer screening, immunizations, dental visits, opioids at high dosage, ER visits, diabetes care, prenatal care, 7-day followup after mental health admission, member satisfaction (CAHPS) and more using 2019 performance scores. Other reports are at this website that may have more information. Released in April 2020 by Georgia Dept. of Community Health at dch.georgia.gov
Find HMO and health insurance plan complaints in Illinois for 2018. 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. The worst HMO complaint ratio for 2018 in plans that had at least $200 million in premiums, was Health Alliance Medical Plans (over 6% market share); six of the largest HMOs had no complaints in 2018. Other HMOs include Aetna, Celtic, Cigna, Health Alliance, United Healthcare (IL and Midwest). For Group Health coverage, the worst 2018 complaint ratio of the large plans was United Healthcare Insurance Company of IL (over 7% market share). The most common insurance complaints overall were about claims handling. Complaint record from 2018 is supplied by the Illinois Dept. of Insurance. Published May 2019; latest available as of March 2021.
Compare complaint index rates for Indiana health insurance companies (health carriers). Highest (worst) 2019 Health Complaint Index of the largest 12 companies (each with at least $60 million in premium) was for CareSource IN. Best was UnitedHealthcare Insurance Co. Delta Dental and WellCare Prescription Insurance Company also had lower complaint rates. From IN Department of Insurance. Updated 2021.
Find Maryland HMO and PPO Health Insurance Plan Ratings for 2020. The only plan to get a full 5-star rating was Kaiser Permanente HMO. Compare KP with Aetna HMO and PPO, CareFirst BlueChoice and GHMSI, Cigna, MAMSI PPO, MD-IPA, Optimum Choice and United Healthcare HMO and PPO. Member satisfaction (CAHPS), getting appointments, flu shots, and many clinical measures of care such as Diabetes, breast cancer screening, behavioral health, well child care are some of the measures. Quality scores are 80% of the overall performance rating. Check Consumer Ratings, Clinical Ratings and Provider Network Ratings that make up the total score. Maryland Health Plan guide is by the Maryland Health Care Commission, updated Dec. 5, 2020.
Maryland HealthChoice Medicaid Health Insurance Plan Ratings are shown in this 2020 Report Card for Consumers. Written in English and Spanish. Compare 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. Only one health plan (JAI) gets 3 stars (the best) across the board. Click on Consumer MCO Report, updated 2020.
Minnesota HMO and Health Insurance Plan 2020 Ratings. Quality (HEDIS 2019 scores) for HMOs show various quality ratings for 2018, but report for each health plan is 191 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 Plan (combined), Hennepin Health, Itasca Medical Care, Medica, PreferredOne, Prime West, Quartz Health Plan, Sanford, South Country Health Alliance, and UCare. Site by MN Dept. of Health. Data refreshed April 2020.
Compare six New Jersey health insurance companies (HMO/POS and PPO/EPO health insurance plans). Performance reports from Aetna, AmeriHealth, CIGNA, Horizon, Oxford and United, on quality ratings related to asthma, COPD, cancer screening, heart care, hypertension, diabetes, new moms, immunizations, strep tests, mental health medication and followup; frequency of imaging tests for lower back pain, cardiac cath and tonsillectomies; well child care, more. Easy to read. 2018 report published by NJ Dept. of Banking and Insurance, June 2019. No updates as of mid-October 2021.
Find New York statewide HMO comparison ratings for 2020. Compare over 20 HMO, PPO or Medicaid managed health insurance plans in NY: Aetna, Affinity, Amida, CDPHP, Crystal Run, CGLIC/CHLIC, Empire Blue Cross Blue Shield, Excellus, Fidelis, GHI or HIP (EmblemHealth), HealthNow New York, Healthfirst, Hudson, Independent Health, MVP, MetroPlus, Molina, Oscar, Oxford, TONY (Total Care Plus), 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 2020, using 2019 member data. health.ny.gov
Find top NCQA ratings for health insurance plans in Rhode Island. Tufts Associated HMO plan earned the top 5.0 rating from NCQA. Based on Quality, Member Satisfaction and accreditation results. 2021-2022 Ratings. Six other health plans earned 4.5 stars.
Find health insurance plan ratings for South Carolina Medicaid, 2021. Compare five South Carolina Medicaid health plan ratings (one to five stars) for Absolute Total Care, First Choice by Select Health of SC, Healthy Blue by BlueChoice of SC, Humana Healthy Horizons, and Molina Healthcare of SC. One total rating only; no detail on specific illnesses, screening, mental health or consumer member satisfaction. First Choice and Molina scored slightly higher in the ratings. No plan received 5 stars. South Carolina Healthy Connections Choices are listed at SCchoices.com.
Compare HMO (Health Maintenance Organization) plans for Central Texas, East Texas, Gulf Coast, North TX, Panhandle/Plains area, South Texas, West Texas regions. TX HMO report cards by OPIC for 2020-2021 show Texas consumer ratings of their health insurance plans and the medical care enrolled members received during 2019. Includes plans covering Austin, Dallas, Ft. Worth, Houston, San Antonio, Abilene, Amarillo, Lubbock, Waco, Corpus Christi and Rio Grande. Satisfaction ratings and market share are shown for Christus (the highest rated plan and the highest rated health care), Blue Cross Blue Shield, Cigna, Humana, Aetna Health, FIRSTCARE, Memorial Hermann, Scott and White Health Plan, Community First and United Healthcare. Report by Texas OPIC (Office of Public Insurance Counsel)
The Guide to Texas HMO Quality 2020-2021 shows detailed clinical quality comparisons of HMO health insurance plans. Compare HMOs Aetna, Christus, Cigna, Community First, FIRSTCARE, HMO Blue Texas, Humana Health Plan, Memorial Hermann, Scott and White, and United Healthcare of Texas. Indicators include asthma, childhood immunizations, cancer screening, heart care, high blood pressure, diabetes care, prenatal care, behavioral health, mental illness care and followup, opioid prescriptions, flu shots, antibiotic utilization rates, rates of physician board certification, and more. Lengthy (226 pages) but valuable report. Published by TX Office of Public Insurance Council
Compare Utah HMOs and PPOs – health insurance plans Aetna, Altius, Cigna, Deseret, Educators Mutual EMI, Humana, PEHP, Regence Blue Cross Blue Shield, SelectHealth, United Health Care, and Medicaid plans (Health Choice, Healthy U, Molina, SelectHealth CHIP) 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. 2018 Performance Report published by utah.gov uses 2017 data. No updates available for 2021 as of October.
Utah Member Satisfaction ratings with their health insurance plans. Compare ratings among commercial health plans (medical), dental plans, Medicaid plans. Adult and Child Results in separate reports. CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey data from Utah Department of Health Office of Health Care Statistics. Consumers were asked to rate both the health plan, and the health care (and their doctors). Survey also measures satisfaction with doctor, communication, quality of care, how quickly you can get an appointment, and more. Some of the more highly rated plans were Deseret Mutual, PEHP, Tall Tree, Regence (for children’s health plans), SelectHealth Medicaid, Healthy U Medicaid, Steward Health Choice, and Molina CHIP for kids. Results were updated November 2020.
Compare Health Insurance plan ratings in Vermont, based on 2020 services. View number of denials, service problems, complaints and grievances on Blue Cross Blue Shield of VT (9.3% claims denial rate), MVP Health Plan (7.34% claims denial rate), and Cigna (9.36% denial rate). Each plan’s report is separate for the year. Act 152 Health Insurer Annual Reports for 2020 were filed with the Vermont Dept of Financial Regulation in 2021.
Compare Virginia HMOs on both quality and member satisfaction. Easy to use tool to compare insurance plan ratings: Aetna, CareFirst BlueChoice, HealthKeepers (both Peninsula and 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 including opioid prescribing, mental health care (e.g., best results for 7-day follow-up after a Mental Health ER visit is CareFirst BlueChoice at 54.5%, compared to Optimum Choice at just 36%), preventive care, spirometry for COPD, prenatal, maternity and newborn care; weight assessment, well child visits and childhood illnesses, member satisfaction for 2019 and more. Also includes Board certification rates for some types of physicians, number of enrollees, and financial data. Updated April 2021.
Find WA clinic and health plan quality ratings reported at WACommunityCheckup.org. Compare care among nearly 2000 clinics in Washington state. See report called Improving Health Care in Washington State. Scroll to Quality Composite Scores to see Medical Group or clinic rankings. Highest rated for 2020 were The Polyclinic, Virginia Mason, and Kaiser Permanente Washington for Commercially insured patients; International Community Health Services, Kaiser Permanente Washington and University of Washington Medical Center were highest for Medicaid patients. Groups also include Swedish Medical Group, UW Physicians, UW Neighborhood Clinics, Yakima Valley Farm Workers Clinic, Northwest Physicians Network, PeaceHealth Medical Group, Palouse Medical, Pacific Medical Centers, The Everett Clinic, Memorial Physicians, MultiCare, Harborview, and hundreds of others. Details are listed under “Organization Detail” in the pop-up for each clinic. Scores and rankings for health insurance plans may be found in older reports. Community Checkup by Washington Health Alliance, 2020 report uses was published September, 2020.
Look up and compare numbers of health insurance plan complaints in Washington for 2020. View one company at a time. Aetna, Kaiser Northwest, Options, Coordinated Care, Delta Dental, Kaiser Foundation Health Plan of Washington (HMO), UnitedHealthcare, Regence BlueShield, Regence Blue Cross, Premera Blue Cross, Moda, Lifewise, Molina, Asuris Northwest, Bridgespan Health and more. Select Company Search tab, then Coverage Type Health, Active only, to see a long list of more than 700 health plan companies. Market Share also shown. Washington State Office of Insurance Commissioner OIC
Find Wisconsin number and rates of grievances in 2020 for WI HMOs, health plans, and Medicare Supplement plans. A grievance is a written complaint. Online tool shows report for every licensed health insurance plan and HMO plan. Examples included Aspirus, Children’s, Compcare, Dean, Group Health Coop, Humana, I-Care, Medica, MercyCare HMO, Network, Quartz, Security, UnitedHealthcare, Unity, WPS and more. Medicare Supplement plan grievances for Aetna, American Family, Blue Cross, Cigna, Genworth, Golden Rule, UnitedHealthCare, Thrivent, and more. Complaints went down in 2020, probably because there were fewer patients getting general medical care due to the pandemic. 2020 data, updated 2021 by State of WI, OCI (Office of the Commissioner of Insurance).
Find an accredited ambulatory health care facility or surgery center. AAAHC, the Accreditation Association for Ambulatory Health Care is a nonprofit that currently accredits over 6,100 organizations in a wide variety of ambulatory health care settings, including ambulatory and office based outpatient surgery centers, community health centers, dental clinics, 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 website for hospital-owned ambulatory surgery center accreditation.)
Health insurance plan cost comparisons in 2021 for Federal government employees. Compare the benefits, member satisfaction, and employee costs for all plans at once. Consumers can also select 3 health insurance plans at one time to see out of network benefits. Web site for Federal Employees Health Benefits (FEHB) Program is from US Office of Personnel Management (OPM). Enrollee premium, deductible, copays and maximum out of pocket costs are shown. Search by zip code; choose local plans and/or national plans. Convenient and current for 2021. Helpful to federal employees and others. The amount that taxpayers and government institutions pay toward the total health care premiums is no longer available, as it was a few years ago.
Search the URAC database of accredited and certified healthcare organizations. URAC is a nonprofit organization that performs accreditation and certification work. Its many accreditation programs include, among others, Specialty Pharmacy Accreditation, Pharmacy Benefit Management, Mail Service Pharmacy, Case Management, Health Call Centers, Health Utilization Management and Review, Telehealth, Telemedicine 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
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 ($9,096 per yr.) Most areas exceeded $10,000 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). Published December 2017.