NCQA: 5-Star health plan performance nearly doubles for 2025

Health plans are performing slightly better this year than they have in the past, with the 2025 Health Plan Ratings from the National Committee for Quality Assurance showing more 5- and 4.5-rated plans, the organization announced.

The Health Plan Ratings list is designed to help healthcare consumers select the best commercial, Medicare Advantage and Medicaid plan for their needs and budget, NCQA said. The ratings take into account clinical quality outcomes and patient experience.

"NCQA Health Plan Ratings are a vital benchmark for transparency, accountability and consumer choice," NCQA President Margaret E. O'Kane said in the announcement. "By spotlighting health plan performance, we help people and employers make informed choices about the partners in their care, while motivating plans to advance quality and member experience across the health care system."

This year's ratings spell good news for healthcare consumers looking for a good experience with their insurer. Of the 998 health plans rated, 11 received a 5-star score, more than doubling the number of plans that got top ratings last year. Of the 11 5-star health plans in this year's report, 8 were commercial plans and 3 were Medicare plans.

Additionally, 55 plans earned a 4.5-star rating, which NCQA said indicates strong improvement in health plan quality.

These improvements were seen across a few different areas of clinical quality, NCQA added. For example, the organization cited year-over-year improvements in coordination and continuity of care for Medicare beneficiaries.

Additionally, NCQA observed improvements in almost all six of the diabetes-related measures it uses in its scoring methodologies. Specifically, for the Kidney Health Evaluation for Patients with Diabetes (KED) measure, there was an average 5% increase across all product lines.

Finally, NCQA reported slightly upward trends in adult and adolescent immunization rates. However, the organization also acknowledged a continued decline in childhood immunization rates, albeit at a slower pace than in the past.

NCQA doubled down on its methodology for the ratings, which it publishes on a five-point scale. Scores are based on 50 measures, including HEDIS scores, Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys and an NCQA review of health plan structure and quality improvement processes.

Sara Heath has reported news related to patient engagement and health equity since 2015.