For the 2017 plan year, HealthCare.gov is introducing a pilot program to present health insurance plan quality ratings (or “star ratings”) for some plans.
Plans in Virginia and Wisconsin will feature the quality ratings this year.
Overall health insurance plan quality ratings
Each rated health plan has an “Overall” quality rating of 1 to 5 stars (5 is highest), which accounts for member experience, medical care, and health plan administration.
This gives you an objective way to quickly compare plans, based on quality, as you shop.
What the health plan star ratings are based on
The plans’ overall rating is based on 3 categories, each with its own star rating:
- Member experience: Based on surveys of member satisfaction with:
- Their health care and doctors
- Ease of getting appointments and services
- Medical care: Based on how well the plans’ network providers manage member health care, including:
- Providing regular screenings, vaccines, and other basic health services
- Monitoring some conditions
- Plan administration: Based on how well the plan is run, including:
- Customer service
- Access to needed information
- Network providers ordering appropriate tests and treatment
All health plans ratings are calculated the same way, using the same information sources.
More on health plan star ratings
- The ratings are based on information the plans provided in 2016. The Marketplace confirmed the information and assigned the ratings.
- In some cases — like when plans are new or have low enrollment — ratings aren’t available. This doesn’t mean the plans are low quality.
- This two-state pilot for the 2017 plan year will help us improve the program in the future.
More information on picking a plan