Arizona Tribune - NCQA Unveils 2026 Health Plan Ratings

WASHINGTON, D.C. / ACCESS Newswire / September 16, 2026 / The National Committee for Quality Assurance (NCQA) announced its 2026 Health Plan Ratings - an annual report that helps healthcare consumers and regulators assess the quality and effectiveness of health plans. Ratings evaluate commercial, Medicare Advantage (MA) and Medicaid health plans based on measures of clinical quality, patient experience and outcomes. The 2026 ratings are based primarily on 2025 performance data, with select MA measures reflecting 2024 results due to federal reporting schedules.

Health plans are rated on a scale of 0-5 stars, with 5 stars representing the highest level of performance. This year, 18 plans earned NCQA's highest 5-star rating, a 64% increase from 2025. The 5-star rated plans include nine commercial plans, five MA plans and four Medicaid plans. An additional 53 plans achieved a 4.5-star rating, a designation that places them among NCQA's highest-rated health plans in the nation.

"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," said Dr. Vivek Garg, President and CEO of NCQA. "When we measure what matters and make performance transparent, we create accountability, accelerate improvement and empower patients to make informed decisions about their care."

Overall, the results point to both higher performance and broader improvement across the market, as average quality scores increased and variation between plans declined. The findings suggest that quality improvement strategies are becoming more effective, scalable and widely adopted throughout the healthcare system.

Key Findings from 2026 Ratings

• Behavioral health leads performance gains: Behavioral Health emerged as one of the highest-performing domains across product lines, reflecting increased investment in mental health access, care coordination and follow-up care. Follow-Up After Hospitalization for Mental Illness (FUH) was among the most improved measures, increasing by 8.9 percentage points in commercial, 9.0 points in Medicaid and 11.9 points in MA.
• Chronic disease management continues to improve: Performance improved on nearly 80% of chronic disease management measures, with 22 of 28 indicators showing year-over-year gains. One standout trend from this year's ratings was that MA plans saw significant improvement in Kidney Health Evaluation for Patients With Diabetes (KED), which increased by 7.3 percentage points. Although chronic care performance improved overall, declines in diabetic eye exam performance highlight an area for closer attention and stronger preventive care.
• Quality is rising as performance gaps narrow: Average benchmark performance increased across commercial, Medicaid and MA, with gains ranging from 1.6 to 1.8 percentage points. Medicaid saw the broadest improvement, with 89% of measures improving year-over-year. At the same time, variation between high- and low-performing plans decreased across all product lines, suggesting that improvements were widespread and not limited to top-performing plans.

Methodology

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

• Clinical quality from NCQA's Healthcare Effectiveness Data and Information Set (HEDIS^®1) and CMS's Health Outcomes Survey (HOS). As of fall 2024, approximately 236 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^®2) surveys.
• NCQA's review of health plan structure and quality improvement processes (NCQA Health Plan Accreditation).

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. Final ratings are displayed as stars rounded to the nearest half-star.

Visit the NCQA website for details on the 2026 Health Plan Ratings, measures and methodology.

About NCQA

NCQA is an independent nonprofit organization that defines and drives healthcare quality through Accreditation, standards, performance measurement and expert support. For more than 35 years, NCQA has advanced transparency, accountability and enabled healthcare organizations to deliver better outcomes for patients. NCQA's Healthcare Effectiveness Data and Information Set (HEDIS^®) is one of healthcare's most widely used performance improvement tools. Learn more at ncqa.org. Follow NCQA on X @ncqa and on LinkedIn at linkedin.com/company/ncqa.

Media Contact
SHIFT Communications
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¹ HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

View the original press release on ACCESS Newswire

Th.Gonzalez--AT