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)
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. Two private commercial plans received the highest possible 5-point rating: Group Health Cooperative of South Central Wisconsin, and Kaiser Foundation Mid-Atlantic States. 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 for 2019
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
Two Kaiser Permanente HMO Plans received the highest ratings. The lowest rating went to Aetna Health of California HMO. Compare 10 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 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), published November 2018.
Find 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, AvMed, Better Health, Capital, CIGNA, Clear Health Alliance, Community, Coventry, Florida Health Care, Freedom Health, Health First, Health Options, Humana, Magellan, Molina, Neighborhood, Positive, Prestige, Simply, Staywell, Sunshine, United Healthcare, Children’s Medical Services and others. Data reflect services received in 2017. Search by county. Additional member satisfaction for PPOs including Capital Health (highest member satisfaction), Florida Blue, Golden Rule (lowest member satisfaction), Aetna, Cigna, Humana, United. Easy to read.
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 Amerigroup 360. Covers access to care, dental visits, opioids at high dosage, ER visits, diabetes care, prenatal care, 7-day followup after mental health admission, member opinions and more using 2016-2017 scores. Other reports are at this website that may have more information. Released in 2018 by Georgia Dept. of Community Health at dch.georgia.gov
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 HMO complaint ratio for 2017 in plans that had at least 10,000 enrollees, was Humana Health Plan; best HMO complaint records were Delta Dental and Health Care Service Corporation (Blue Cross Blue Shield of IL). Complaint record from 2017, supplied by the Illinois Dept. of Insurance. Other HMOs include Aetna, Celtic, Cigna, Health Alliance, United Healthcare (IL and Midwest). For Group Health coverage, the worst 2017 complaints per 10,000 policies for plans enrolling at least 100,000 people were UnitedHealthcare Insurance Company of River Valley United’s Illinois plan. The most common HMO, group and individual plan complaints were about claims handling.
Compare complaint rates for Indiana health insurance companies (health carriers). Highest 2017 Complaint Index of the largest 13 companies (each with at least $60 million in premium) were for CareSource IN, MDwise Marketplace Inc, All Savers Ins Co, Indiana University Health Plans Inc. and Humana Ins Co. Best was Aetna From IN Department of Insurance
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
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
Quality (HEDIS 2018 scores) for HMOs show various quality ratings for 2017, but report for each health plan is 148 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. Data refreshed February 2019.
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
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 2018, using 2017 member data. health.ny.gov
Tufts Associated HMO plan earned the top 5.0 rating from NCQA. Based on Quality, Member Satisfaction and accreditation results. 2017-2018 Ratings
Compare four South Carolina Medicaid health plan ratings (one to five stars) for Absolute Total Care, Healthy Blue by BlueChoice of SC, Molina Healthcare of SC and WellCare. One total rating only; no detail on specific illnesses, screening, mental health or consumer member satisfaction. Absolute and Health Blue scored slightly higher in the ratings. Click on How is Your Health Plan Rated. No plan received 5 stars. First Choice by Select Health of SC and S.C. Solutions are not listed. South Carolina Healthy Connections Choices are listed at SCchoices.com.
Texas consumer ratings of their health insurance plans and the medical care enrolled members received during 2017. Compare HMO (Health Maintenance Organization) plans for Central Texas, East Texas, Gulf Coast, North TX, Panhandle/Plains area, South Texas, West Texas regions. 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 Humana, Aetna Health, Christus (the highest rated plan and the highest rated health care), FIRSTCARE, Memorial Hermann, Scott and White Health Plan, Community First, HMO Blue Texas, Cigna and United Healthcare. Report by Texas OPIC (Office of Public Insurance Counsel)
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
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
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
Compare complaints and grievances on Blue Cross Blue Shield of VT (0.82 per 1000 members), MVP (0), and The Vermont Health Plan (6.09 per 1000 members). Each plan’s report is separate for 2017. Act 152 Health Insurer Annual Reports for 2018 are from Vermont Dept of Financial Regulation.
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.
Compare care among 300 medical groups in Washington state. Scroll to Medical Group Performance to see medical group rankings beginning on Figure 5. Highest rated for 2018 were Virginia Mason, Kaiser Permanente Washington and The Polyclinic for Commercially insured patients; UW Medicine-Valley Medical Group and International Community Health Services were highest for Medicaid patients. Groups also include Swedish Medical Group, Pacific Medical Centers, The Everett Clinic, Columbia Medical Associates, Family Care Network, Women’s Healthcare Alliance, Northwest Physicians Network, MultiCare, UW Neighborhood Clinic and hundreds of others. For two measures, 10 health insurance plans and 9 accountable communities of health (ACOs) were compared. See report called Improving Health Care in Washington State. Community Checkup by Washington Health Alliance, uses 2016-2017 data, published December 2018
Compare number of complaints for WA health insurance plans for 2018. View one company at a time. Aetna, Kaiser Northwest, Options, Coordinated Care, Delta Dental, Kaiser, 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, to see a long list of health plan companies. Market Share also shown. Washington State Office of Insurance Commissioner OIC
View graphs comparing rates in WI 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 and HMOs: Dean, Group Health Coop, Gundersen Lutheran, Humana, Medical Associates, Medica, MercyCare HMO, Network, Physicians Plus, UnitedHealthcare, Unity, WPS and more. 2015 data, last updated January 2017 by State of Wisconsin, OCI
The nonprofit Accreditation Association for Ambulatory Health Care (AAAHC) currently accredits over 6100 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.)
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 for 2019. The amount that taxpayers and government institutions pay toward the total health care premiums is no longer readily available
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, 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 ($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). Published December 2017.