Behind the Health Insurance Plan Rankings

This is the fourth year that U.S. News and the National Committee for Quality Assurance, managed care's major accrediting and standards-setting body, have teamed up to rank healthcare plans. We release the rankings during open-enrollment season, when millions of Americans prepare to select their healthcare coverage for the next year. Go here to view the top 50 commercial plans, top 25 Medicare plans, and top 25 Medicaid plans.

Cost plays a large role in plan choice, of course. But data analyzed by NCQA and provided to U.S. News about hundreds of plans permit quality to be considered as well. The rankings, at health.usnews.com/healthplans, show how well plans do at preventing and treating illness and providing consumer services to members.

If your family includes a toddler, for instance, how hard a plan works to keep immunizations current is good to know. Families with diabetic members can see a plan's success at keeping LDL cholesterol below critical levels. Diligence in screening for cervical cancer with a Pap test was one of 49 measures that went into evaluating commercial plans and 39 measures for judging Medicaid plans. (Medicare plans were weighed using 42 measures.) Data were even requested about children who were diagnosed with a common cold and did not get an antibiotic. That was a way to determine how readily caregivers hand out antibiotics on demand, a common practice that contributes to the rise in drug-resistant bugs.

Getting satisfaction. Measures about consumer services included members' opinions about the ease of making appointments and getting care, doctors' ability to communicate effectively, and satisfaction with claims handling.

The 469 ranked plans received scores of 0 to 100 and overall ratings of 1 to 5 stars. Star ratings are also shown for individual measures, combinations of measures (such as "women's reproductive health"), and the three major categories—prevention, treatment, and consumer assessment. An additional 94 plans did not provide enough data to be ranked but are listed with the information available.

The top 10 commercial plans, top five Medicare plans, and top five Medicaid plans make up the Honor Roll. Most of the ranked plans are HMOs or combined HMO-POS plans (see glossary).

Not all plans furnished data to NCQA, and some did so but refused to make the information public. These 126 plans are all labeled nonreporters and are ineligible for ranking or NCQA accreditation.