HealthCare.gov offers a health insurance plan quality ratings (or “star ratings”) program.
Overall Health Insurance Plan Quality Ratings
A plan’s 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 plan’s network providers manage member health care, including:
- Providing regular screenings, vaccines, and other basic health services
- Monitoring some 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 ratings are based on information the plans provided. The Marketplace confirmed the information and assigned the ratings. Due to coronavirus disease 2019 (COVID-19) emergency, ratings for 2021 are based on data provided in 2019.
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.
A Few Things to Know Before You Pick A Plan
Choosing a Health Insurance Plan can be complicated. Knowing just a few things before you compare plans can make it simpler.
- The 4 “metal” categories: There are 4 categories of health insurance plans: Bronze, Silver, Gold, and Platinum. These categories show how you and your plan share costs. Plan categories have nothing to do with quality of care.
- Your total costs for health care: You pay a monthly bill to your insurance company (a “premium”), even if you don’t use medical services that month. You pay out-of-pocket costs, including a deductible, when you get care. It’s important to think about both kinds of costs when shopping for a plan.
- Plan and network types: HMO, PPO, POS, and EPO: Some plan types allow you to use almost any doctor or health care facility. Others limit your choices or charge you more if you use providers outside their network.