NCQA Releases 2026 Health Plan Ratings With Improved Performance Across Sectors

The National Committee for Quality Assurance (NCQA) has released its 2026 Health Plan Ratings, highlighting significant improvements in the quality of health plans across various sectors. This annual report, which evaluates commercial, Medicare Advantage (MA), and Medicaid health plans, provides a comprehensive assessment of their performance in clinical quality, patient experience, and outcomes.

This year, 18 health plans earned the top 5-star rating, marking a 64% increase from the previous year. Among these, nine plans were commercial, five were MA, and four were Medicaid plans. Additionally, 53 plans achieved a 4.5-star rating, placing them among the highest-rated health plans in the nation.

Dr. Vivek Garg, President and CEO of NCQA, emphasized the progress reflected in the ratings.

The ratings are based on measures from the Healthcare Effectiveness Data and Information Set (HEDIS®) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys. According to the NCQA, the 2026 ratings are primarily based on 2025 performance data, with some Medicare Advantage measures reflecting 2024 results due to federal reporting schedules.

Key findings from the 2026 ratings include:

1. Behavioral Health Performance: Behavioral health emerged as one of the highest-performing domains across all product lines. The Follow-Up After Hospitalization for Mental Illness (FUH) measure showed significant improvement, increasing by 8.9 percentage points in commercial plans, 9.0 percentage points in Medicaid plans, and 11.9 percentage points in MA plans.

2. Chronic Disease Management: Performance improved on nearly 80% of chronic disease management measures. One notable trend was the significant improvement in the Kidney Health Evaluation for Patients With Diabetes (KED) measure for MA plans, which increased by 7.3 percentage points. However, declines in diabetic eye exam performance highlighted an area that requires closer attention and stronger preventive care.

3. Overall Quality Improvement: Average benchmark performance increased across commercial, Medicaid, and MA plans, with gains ranging from 1.6 to 1.8 percentage points. Medicaid plans showed the broadest improvement, with 89% of measures improving year-over-year. At the same time, variation between high- and low-performing plans decreased, indicating that improvements were widespread and not limited to top-performing plans.

The NCQA's ratings are calculated on a 0-5 scale, with 5 stars representing the highest level of performance. The final ratings are displayed as stars, rounded to the nearest half-star. The organization's website provides detailed information on the 2026 Health Plan Ratings, measures, and methodology.

The 2026 ratings reflect a significant improvement in the quality of health plans, particularly in behavioral health and chronic disease management. These findings highlight the effectiveness of quality improvement strategies and the commitment of health plans to delivering better outcomes for patients.