Health Plan Quality Ratings

Covered California’s quality ratings show how our health plans compare on helping members get the right medical care, and on member-reported experiences of care and service.

Covered California has been reporting quality ratings since day one. These ratings play an important role in helping Californians get better care at affordable prices. California health plans perform well in most areas: Several Covered California plans earned very high or top ratings, and half of the plans are rated three-star or higher on members’ getting the right medical care. But the performance standards set by the highest-performing plans tells us that some plans can do better.

Covered California is working with its health insurance companies to improve the quality and overall value of the coverage they offer. Key efforts include seeing that every member is matched to a primary care clinician; connecting the sickest enrollees with health care organizations that have demonstrated superior-quality care; identifying and eliminating gaps in good care across populations of people who differ by ethnicity, race or income; and advancing health care technology to improve care and eliminate unsafe practices.

Health Plan Quality Ratings for the 2018 Coverage Year

Plans are rated on a scale of one to five stars. To assign the star rating, each health plan’s results are compared to more than 300 health plans nationwide. A five-star plan means that that health plan scored among the top plans nationwide; a one-star rating means the plan’s score was among the lowest.

Individual and Family Plans
Issuer Product Type Overall Quality Rating
(1-5 stars)
Getting the Right Care Members’ Care Experience Plan Services for Members
Anthem Blue Cross of California
Product Type
EPO
Quality Rating Not Available*
Blue Shield of California (PPO)
Product Type
PPO
Overall Quality Rating (1-5 stars)
Getting the Right Care
Members’ Care Experience
Plan Services for Members
Blue Shield of California (HMO)
Product Type
HMO
Quality Rating Not Available*
Chinese Community Health Plan
Product Type
HMO
Overall Quality Rating (1-5 stars)
Getting the Right Care
Members’ Care Experience
Plan Services for Members
Health Net (HMO)
Product Type
HMO
Overall Quality Rating (1-5 stars)
Getting the Right Care
Members’ Care Experience
Plan Services for Members
Health Net (EPO)
Product Type
EPO
Overall Quality Rating (1-5 stars)
Getting the Right Care
Members’ Care Experience
Plan Services for Members
Health Net (Enhanced Care PPO)
Product Type
Enhanced Care

PPO

Quality Rating Not Available*
Kaiser Permanente
Product Type
HMO
Overall Quality Rating (1-5 stars)
Getting the Right Care
Members’ Care Experience
Plan Services for Members
L.A. Care Health Plan
Product Type
HMO
Overall Quality Rating (1-5 stars)
Getting the Right Care
Members’ Care Experience
Plan Services for Members
Molina Healthcare
Product Type
HMO
Overall Quality Rating (1-5 stars)
Getting the Right Care
Members’ Care Experience
Plan Services for Members
Oscar Health Plan of California
Product Type
HMO
Quality Rating Not Available*
Sharp Health Plan
Product Type
HMO
Overall Quality Rating (1-5 stars)
Getting the Right Care
Members’ Care Experience
Plan Services for Members
Valley Health Plan
Product Type
HMO
Overall Quality Rating (1-5 stars)
Getting the Right Care
Members’ Care Experience
Plan Services for Members
Western Health Advantage
Product Type
HMO
Overall Quality Rating (1-5 stars)
Getting the Right Care
Members’ Care Experience
Plan Services for Members
Covered California for Small Business Plans
Issuer Product Type Overall Quality Rating
(1-5 stars)
Getting the Right Care Members’ Care Experience Plan Services for Members
Blue Shield
Product Type
HMO
Quality Rating Not Available*
Chinese Community Health Plan
Product Type
HMO
Overall Quality Rating (1-5 stars)
Getting the Right Care
Members’ Care Experience
Plan Services for Members
Health Net (PPO)
Product Type
PPO
Overall Quality Rating (1-5 stars)
Getting the Right Care
Members’ Care Experience
Not Rated
Plan Services for Members
Health Net (Enhanced Care PPO)
Product Type
Enhanced Care
PPO
Quality Rating Not Available*
Kaiser Permanente
Product Type
HMO
Overall Quality Rating (1-5 stars)
Getting the Right Care
Members’ Care Experience
Plan Services for Members
Sharp Health Plan
Product Type
HMO
Overall Quality Rating (1-5 stars)
Getting the Right Care
Members’ Care Experience
Plan Services for Members
* Quality ratings are reported for a health plan product after its first two years with Covered California

How Quality Is Measured

Covered California provides consumers with an overall quality rating and individual ratings for three major aspects of health plan performance.

Overall Quality Rating: An overall quality rating is constructed for each health plan that has at least two of the three component scores, and one of the scores must be for the clinical care topic.

Getting the Right Care: Each year, a sample of members from each health plan is selected and their records are checked to compare their medical care with national standards for care and treatments that are proven to help patients. More than 30 aspects of health care quality are tracked by checking patients’ medical charts and the billing records sent by doctors and hospitals. These quality measures include things like how well the health plan and its doctors help people control high blood pressure, lower their cholesterol and get the right medications.

Members’ Care Experience: Members’ experiences with their doctor and care are based on a survey that asked about their recent experiences when visiting the doctor and getting medical care. About one of every five people who got a survey in the mail or by phone sent in their answers, with about 250 members from each plan completing surveys. (For one plan there is no quality rating because too few members answered the survey.)

Plan Services for Members: A sample of plan members’ records is checked to see if patients got unnecessary care — services that could be harmful and a waste of your time and money. And, another part of the member survey is used to report on members’ experiences in getting help and information from the health plan’s customer service staff.