11 Health Plans Earn Top 5-Star Rating

WASHINGTON, D.C., 3683 / ACCESS Newswire / September 16, 2025 / The?National Committee for Quality Assurance?(NCQA) today announced its 2025 Health Plan Ratings-an annual report that helps health care consumers and regulators assess the quality and effectiveness of health plans. Ratings evaluate commercial, Medicare Advantage and Medicaid health plans based on measures of clinical quality and patient experience. 2025 Health Plan Ratings are primarily based on 2024 performance data, with some Medicare Advantage metrics reflecting 2023 results due to reporting schedules.

Health plans are rated on a scale of 0-5 stars. NCQA awards 4.5-5 stars to health plans that are the highest-rated in the nation, exemplifying high-quality care, excellent clinical results, strong member satisfaction and improved health outcomes. This year, 11 out of 998 rated plans achieved a 5-star rating, more than double last year's total of five. Of those, eight were commercial plans and three were Medicare plans. Additionally, 55 plans earned a 4.5-star rating, demonstrating strong performance across multiple key quality domains.

"NCQA Health Plan Ratings are a vital benchmark for transparency, accountability and consumer choice," said NCQA President Margaret E. O'Kane. "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."

Advancing Data Transparency to Improve Health Outcomes

NCQA continues to strengthen its focus on creating evidence-based quality measures that address disparities and improve health outcomes for everyone. This year, the Language Diversity of Membership (LDM) measure was introduced to the scoring framework, with an initial weight of 0.5. LDM evaluates whether plans actively identify and collect data on members' preferred spoken and written languages, with the goal of identifying communication gaps and guiding quality improvement initiatives to ensure all member populations receive high-quality, accessible care.

Key Findings from 2025 Ratings

  • Stronger transitions of care in Medicare: Year-over-year improvements highlight stronger coordination and continuity of care for beneficiaries.

  • Progress in diabetes and kidney health: Nearly all six diabetes-related measures showed improvement, with the Kidney Health Evaluation for Patients with Diabetes (KED) measure showing an average increase of more than 5% across all product lines.

  • Improving immunization trends: Adult and adolescent immunization rates trended upward, while childhood immunization rates continue to decline-though at a reduced pace compared to last year.

Methodology

Each year, NCQA rates health plans that choose to publicly report their data. Ratings are based on nearly 50 measures of clinical performance and patient experience, including:

  • Clinical quality from NCQA's Healthcare Effectiveness Data and Information Set (HEDIS®) and CMS's Health Outcomes Survey (HOS). As of fall 2023, approximately 235 million people were enrolled in health plans that reported HEDIS. Enrollment figures are updated annually to reflect the most current data available.

  • Patient experience from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys.

  • NCQA's review of health plan structure and quality improvement processes (NCQA Health Plan Accreditation).

Overall Ratings are calculated on a 0-5 scale (with 5 being the highest) as a weighted average of a plan's HEDIS, CAHPS and HOS measure ratings, plus bonus points if the plan is Accredited by NCQA, and are displayed as stars rounded to the nearest half-point.

Visit the NCQA website for details on the 2025 Health Plan Ratings, measures and methodology.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

About NCQA

NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA Accredits and Certifies a wide range of health care organizations. It also Recognizes clinicians and practices in key areas of performance. NCQA's Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA's website (ncqa.org) contains information to help consumers, employers and others make informed health care choices. NCQA can also be found at Twitter/X?@ncqa?and on LinkedIn at?linkedin.com/company/ncqa.

Media Contact

SHIFT Communications
[email protected]

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SOURCE: NCQA



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