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October 3, 2017

Maine among top 10 states with 'highest-rated health insurance plans'

A new report from the National Committee for Quality Assurance, a private nonprofit organization focused on improving health care quality, ranks Maine as the third-best state in the country for the quality of its health insurance plans.

The Top 10 list is created from NCQA's 2017-18 Health Insurance Plan Ratings, which compare the quality and services of more than 1,000 health plans in the United States and provide consumers with a practical and meaningful guide to understanding their health care options and choosing the best health plans for themselves and their families.

The ratings are a system similar to CMS Star Ratings of Medicare Advantage plans and are weighted to give importance to health outcomes and consumer satisfaction.

NCQA studied 1,429 health plans and rated 1,062: 498 private (commercial), 386 Medicare and 178 Medicaid.

Maine ranked third in the top 10 list for states receiving a 4.5 or 5.0 out of a '5' rating as a three-year average: 1) Massachusetts; 2) Rhode Island; 3) Maine; 4) New Hampshire; 5) Wisconsin; 6) Minnesota; 7) Hawaii; 8) New York; 9) Vermont; 10) Iowa.

Key takeaways

Here are the key takeaways from NCQA's 2017–18 ratings:

States with the top performing plans consistently deliver: Over the last three years, there's been very little movement within the top 10 states except for Iowa and Hawaii, that in 2015 were 12th and 11th respectively and moved into the top 10 in 2016 and 2017.

High and low performers are rare: Of the 1,062 rated plans, 103 (10%) received a top rating of 4.5 or 5.0 out of 5; 23 (2%) earned the ratings of 1.0 to 2.0.

The ratings consist of three major performance categories: consumer satisfaction, prevention and treatment.

  • Consumer satisfaction: What patients say about their health plans in satisfaction surveys, including about claims processing and customer service.
  • Prevention: Checkups, tests and other care that keeps people — especially children — healthy.
  • Treatment: How consistently a plan provides scientifically recommended care for common, costly conditions such as diabetes, depression and heart disease.

In each category, the outcomes of a patient's care count extra in the scoring; for example, whether blood pressure and diabetics' blood sugar are controlled to safe, recommended levels.This emphasis on results means that, together with consumer satisfaction, outcomes are the main driver of ratings results.

In a news release announcing this year's rankings, NCQA stated that the ratings blend dozens of quality indicators for health plans into a simple scale from 1 to 5, where "1" indicates lower performance and "5" indicates higher performance.

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