Every year, the National Committee for Quality Assurance (NCQA) evaluates and rates health insurance plans across all 50 states, U.S. territories, and the District of Columbia. These ratings provide valuable insights into how well plans perform on critical health metrics and the level of satisfaction members report regarding their care. By making this information accessible to the public, NCQA aims to empower consumers, employers, and policymakers to make better-informed healthcare choices and incentivize health plans to continually enhance their quality and member-focused services.
How Ratings Are Determined
Health plans are assessed on a star-based system ranging from 0 to 5 stars. Plans earning 4.5 and 5 stars are considered the top-tier health plans in the country. The rating process evaluates three core aspects of healthcare quality:
- Clinical performance measured through HEDIS® (Healthcare Effectiveness Data and Information Set) and the Health Outcomes Survey (HOS).
- Patient experience and satisfaction gauged through the Consumer Assessment of Healthcare Providers and Systems (CAHPS®).
- The structural quality and operational processes of the health plan, reviewed via NCQA’s accreditation standards (NCQA Health Plan Accreditation).
The overall rating reflects a weighted combination of scores from these three areas, with additional points awarded to plans that hold NCQA accreditation. This comprehensive approach ensures a balanced view of both clinical outcomes and member experience.
Top-Rated Plans in the Nation
Below is a list of the highest-rated health plans across the United States. For more detailed information about each plan, visit NCQA’s official website. Recognized plans have achieved the highest ratings, often earning 4.5 or 5 stars, demonstrating excellence in healthcare delivery.
| Plan Name | State(s) | Product Line & Reporting | Overall Rating |
|————|———-|————————–|—————-|
| Blue Cross and Blue Shield of Massachusetts, Inc. | MA | Commercial PPO | 5 |
| Independent Health Association, Inc. | NY | Commercial HMO/POS | 5 |
| Kaiser Foundation Health Plan Inc. – Southern California | CA | Commercial HMO | 5 |
| Kaiser Foundation Health Plan Inc. – Southern California | CA | Medicare HMO | 5 |
| Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. | DC, MD, VA | Commercial HMO | 5 |
| Kaiser Foundation Health Plan, Inc. – Northern California | CA | Commercial HMO | 5 |
| Kaiser Foundation Health Plan, Inc. – Northern California | CA | Medicare HMO | 5 |
| Network Health Insurance Corporation (NHIC) | WI | Medicare PPO | 5 |
| UPMC Benefit Management Services, Inc. | PA | Commercial HMO | 5 |
| UPMC Health Coverage, Inc. | PA | Commercial HMO | 5 |
| UPMC Health Plan, Inc. | PA | Commercial HMO | 5 |
Note: Ratings are based on NCQA’s 2025 Health Plan Ratings. Plans that submitted incomplete data or no data at all did not receive an evaluation.
Quality Measures and Standards
NCQA’s assessments incorporate various performance metrics, including clinical quality measures and patient feedback. HEDIS® scores, which evaluate preventive care, management of chronic diseases, and other clinical standards, are a key component. CAHPS® surveys capture members’ experiences with their healthcare providers and plan services. Additionally, accreditation reviews examine the infrastructure and operational processes that support high-quality care delivery.
For developers interested in healthcare technology, understanding the standards and best practices in healthcare application development is crucial. Insights can be found in resources like this guide on developing healthcare apps, which emphasizes key considerations for creating effective and compliant solutions.
The Impact of Technology in Healthcare Ratings
Innovations such as extended reality (XR) are transforming patient engagement and provider training, effectively bridging gaps in modern medicine. Learn more about this technological revolution at this article on XR’s role in healthcare.
Moreover, artificial intelligence continues to make significant strides in healthcare, improving diagnostics, treatment plans, and operational efficiencies. For an in-depth understanding of AI’s influence, explore how AI is aiding healthcare sectors.
Historically, AI’s integration into healthcare dates back several decades, evolving from simple diagnostic tools to advanced systems now capable of supporting complex medical decisions. To discover more about that progression, see a concise history of AI in healthcare.
Final Thoughts
High-rated health plans exemplify excellence in healthcare quality, patient satisfaction, and operational efficiency. Staying informed about these top performers enables consumers and organizations to select plans that prioritize member well-being and continuous improvement. As technology advances, the integration of innovative solutions will further elevate care standards, making healthcare more accessible, personalized, and effective for everyone.