Quality ratings of health plans in the SHOP Marketplace

Starting in 2017, HealthCare.gov is introducing a pilot program to present quality ratings (or “star ratings”) for some Small Business Health Option Program (SHOP) health insurance plans.

SHOP plans in Virginia and Wisconsin will feature the quality ratings during this pilot.

Overall health insurance plan quality ratings

Each rated SHOP health plan has an “Overall” quality rating of 1 to 5 stars, which accounts for member experience, medical care, and health plan administration.

This gives you an objective way to quickly compare SHOP insurance plans based on quality.

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 health 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 plan ratings are calculated the same way, using the same information sources.

More on health plan star ratings

  • The SHOP Marketplace health plan 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 2017 will help us improve the program in the future.