Participation
Why aren't all organizations listed?
To appear in NCQA's Health Plan Report Card, an organization must earn NCQA Accreditation. Neither HMOs nor PPOs are legally required to earn NCQA Accreditation, and the process is quite rigorous so not all organizations will be found on the list. Among HMOs, about half the plans in the country are NCQA-Accredited. Among PPOs, far fewer are included. In fact, because PPO Accreditation is still relatively new (the program was introduced in 2000) only a handful of the leading PPOs in the country have been accredited to date. If an HMO or PPO has not been accredited or scheduled a survey, NCQA encourages consumers to ask why. Accreditation is designed to review, among other things, the organization's systems for protecting patients, safeguarding members' confidential information, ensuring access and resolving grievances. Enrolling in an NCQA Accredited organization is one of the best ways to ensure that you and your family will get the care, service and consideration you need, when you need it.
Special note about new health plans:
New health plans (established within the past three years) may be accredited under our Accreditation Program for New Health Plans. If a plan you're considering is relatively new, consult The New Health Plan Status List to see if they were accredited under this program.
What can I do if my plan isn't accredited?
Health plans are responsive to their members' and potential members concerns. If you're a member of a plan that isn't accredited, or if you're considering joining a non-accredited health plan, think twice and let the plan know that you would feel more comfortable if it earned NCQA Accreditation. If you receive health care coverage through your employer, talk with them about offering NCQA-accredited plans. Health plans are much more likely to focus on quality and go through the accreditation process if encouraged to do so by health plan members and employers who make decisions about which plans to choose.
Accreditation Statistics
NCQA updates the Health Plan Report Card database every month. The chart below reflects the NCQA Accreditation Outcomes for the
217 Commercial Health Plans,
63 Medicaid Health Plans and 79 Medicare Health Plans with current decisions as of
. Because the PPO Accreditation program is new, PPO outcomes are not included in these statistics.
