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.
Star Ratings for 2023
Plans are rated on a scale of one to five stars. To assign the star rating, each health plan’s results are compared to about 200 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.1
* Quality ratings are reported for a health plan product after its first two years with Covered California.
** Not enough data to calculate a score.
How Quality Is Measured
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. A number of California health plans perform well in most areas and no plans were scored an overall 1-star rating. But the performance standards set by the highest-performing plans, in California and nationwide, 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; measuring performance for a priority set of measures; aligning contract requirements with other California state agencies; identifying and eliminating gaps in good care across populations of people who differ by ethnicity, race or income; holding plans financially accountable for improving quality and addressing health disparities; and advancing health care technology to improve access to care.
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 by summarizing all of their quality results. To be rated the health plan must have at least two of the three component scores to include the Getting the Right Care score.
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.
Plan Services for Members: A sample of plan members’ records is checked to see if patients received unnecessary care — services that could be harmful and a waste of your time and money. 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.
1 “Plan quality ratings and enrollee survey results are calculated by the Centers for Medicare & Medicaid Services (CMS) using data provided by health plans in 2022. No star ratings were issued for the new Health Net Ambetter PPO. Quality ratings displayed are based on Health Net Ambetter PPO members’ care and experiences for a nearly identical, discontinued product. The ratings are being displayed for health plans for the 2023 plan year. Learn more about these ratings at CMS’ Health Insurance Marketplace Quality Initiatives website: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/ACA-MQI/ACA-MQI-Landing-Page.”
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