The National Committee for Quality Assurance (NCQA) recently published its 2026 health plan ratings, revealing a striking 64% increase in the number of health plans awarded a 5-star rating from the previous year. This data highlights a growing trend toward enhanced quality within the healthcare system.
A total of 18 health plans earned the top 5-star rating, which includes nine commercial plans, five Medicare Advantage plans, and four Medicaid plans. Noteworthy organizations achieving this designation include UPMC Health Plan, Blue Cross and Blue Shield of Massachusetts, and Harvard Pilgrim Health Care, among several Kaiser Foundation Health Plans. In addition, 53 plans received a 4.5-star rating, indicating a substantial rise in overall quality.
The NCQA's annual ratings are crucial for both consumers and regulators, as they provide measurable benchmarks for assessing the quality and effectiveness of various health plans. Dr. Vivek Garg, president and CEO of NCQA, emphasized the significance of this year’s findings, stating, "The progress reflected in this year’s Health Plan Ratings is encouraging because it demonstrates meaningful improvement in the areas that matter most to patients, such as behavioral health and chronic disease management." By making performance visible, NCQA aims to foster accountability, enhance improvement efforts, and empower patients in their healthcare choices.
The 2026 ratings reveal that the average quality scores across health plans have increased, with decreasing variation between top and bottom performers. This suggests that the strategies for quality improvement have gained traction, becoming more effective and widely integrated throughout the healthcare sector. Such advancements could imply that quality enhancement methods are becoming standard practice among health plans.
One of the most promising areas of improvement identified in the NCQA report is behavioral health. The rise in quality can be attributed to increased investments in mental health services, care coordination, and vigilant follow-up care after hospitalization. Specifically, the report highlights substantial advancements in follow-up care for mental illness across commercial plans, Medicaid, and Medicare Advantage plans.
Additionally, progress in chronic disease management has been notable, with performance improvements on nearly 80% of relevant measures. Among these, Medicare Advantage plans showed significant enhancements in kidney health evaluations for patients with diabetes, with performance rising by 7.3 percentage points.
Despite these strides, there remain areas requiring focus and improvement. For instance, while chronic care performance overall has improved, there was a noticeable decline in diabetic eye exam performance. This decline underscores the need for stronger preventive care measures in chronic disease management.
The NCQA indicated that while average benchmark performance improved across various plan types, the gains were consistent, ranging from 1.6 to 1.8 percentage points across commercial, Medicaid, and Medicare Advantage plans. Particularly, Medicaid showcased the most extensive progress, with 89% of measures improving from the previous year.
The methodologies employed in the NCQA ratings involve a comprehensive evaluation of clinical quality, patient experience, and health plan structure and processes. The assessment utilizes data from numerous sources, including HEDIS and the Centers for Medicare & Medicaid Services’ Health Outcomes Surveys, as well as surveys from the Consumer Assessment of Healthcare Providers and Systems and NCQA’s Health Plan Accreditation. Health plans are rated on a scale from 0 to 5 stars, allowing for comparative analysis of performance.
As the landscape of healthcare continues to evolve, the NCQA's report serves as essential guidance for consumers looking to make informed choices regarding their health plans. The marked improvements in health plan quality illustrate the effectiveness of strategic investments and a collective focus on elevating patient care standards. With this upward trend, even greater strides in overall healthcare quality may soon be anticipated.
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