Overview

There isn’t one health insurance company that is best for everybody. Your location and personal health history influence the best choice for you. Health insurance companies are different in each state, and certain plans are better than others depending on your health. However, there are companies and plans that rank highly in various studies and customer service surveys. Here’s what to know.

Top-rated companies and plans based on location

These companies’ resources are helpful when looking for health insurance company rankings:

Each of them uses different criteria when evaluating health insurance companies and their plans.

The J.D. Power Member Health Plan Study is based on responses from more than 31,000 members of 134 commercial health plans across 18 regions in the United States. They created a 1,000-point scale examining 6 key factors:

  • coverage and benefits
  • provider choice
  • information and communication
  • claims processing
  • cost
  • customer service

Here are the results for the top-ranking insurance provider based on location:

  • California, Colorado, Mid-Atlantic, Northwest, South Atlantic: Kaiser Foundation Health Plan
  • East South Central: Blue Cross Blue Shield of Alabama
  • Florida: AvMed
  • Heartland: Blue Cross Blue Shield of Kansas
  • Illinois-Indiana: Blue Cross Blue Shield of Illinois
  • Michigan: Health Alliance Plan of Michigan
  • Minnesota-Wisconsin: Dean Health Plan
  • Mountain: SelectHealth
  • New England: Anthem Health Plans of New Hampshire
  • New York-New Jersey: Capital District Physicians’ Health Plan, Inc.
  • Ohio: United Healthcare
  • Pennsylvania: Highmark BlueCross BlueShield
  • Southwest: Cigna
  • Texas: BlueCross BlueShield of Texas and United Healthcare (tied)

Top-rated companies and plans based on condition

As mentioned, no company or plan is best for everyone. Factors such as location, current health, and financial budget make a difference.

The National Committee for Quality Assurance (NCQA) gives scores to health plans from different health insurance companies based on health condition. This can help you compare similar plans. These scores are based on customer satisfaction, prevention, and treatment.

If you’re pregnant

Here are the NCQA scores based on two evaluating questions: Did pregnant women have prenatal checkups after enrolling in the plan, and did mothers have postpartum care shortly after delivering their babies?

These are two examples of the best plans for pregnant women based on their scores:

1. Kaiser Permanente – CA HMO plan

Treatment aspectRating out of 5.0
Prenatal checkups5.0
Postpartum care5.0

2. Anthem BlueCross BlueShield – CT HMO/POS plan

Treatment aspectRating out of 5.0
Prenatal checkups5.0
Postpartum care4.0

If you have children

The NCQA scores are based on several evaluating questions:

  • Did children receive the recommended immunizations?
  • Did children receive nutrition counseling?
  • Did infants up to 15 months get up to 6 well-care visits?
  • Did children ages 12 to 21 years have at least 1 visit to their primary care doctor in the past year?

Here are two examples of the best plans for families with children based on their scores:

1. Cigna – MA HMO/POS/PPO plan

Treatment aspectRating out of 5.0
Childhood immunizations5.0
Nutrition counseling5.0
Infant well-care visits5.0
Adolescent well-care visits5.0

2. Anthem BlueCross BlueShield – CT HMO/POS plan

Treatment aspectRating out of 5.0
Childhood immunizations5.0
Nutrition counseling5.0
Infant well-care visits4.0
Adolescent well-care visits5.0

If you have a chronic condition

One way to evaluate plans if you have a chronic condition is to look at how the health insurance companies score for treatment of that condition. The follow NCQA scores are based on the treatment of three example conditions:

1. Kaiser – CA HMO plan

ConditionTreatment rating out of 5.0
Asthma3.0
Diabetes5.0
Heart disease5.0

2. BlueCross BlueShield – MA PPO plan

ConditionTreatment rating out of 5.0
Asthma2.0
Diabetes4.5
Heart disease5.0

If you have a mental or behavioral disorder

The NCQA scores are based on several evaluating questions:

  • Did members of the plan with a new episode of depression take a prescription for 12 weeks?
  • Did members of the plan who were hospitalized for a mental illness have two follow-ups within a month of their discharge?
  • Did alcohol- or drug-dependent members of the plan receive inpatient and outpatient care?
  • Did members of the plan prescribed with ADHD medication have a follow-up appointment with 30 days?

1. Kaiser – CA HMO plan

Treatment aspectRating out of 5.0
Adhering to depression medication for 12 weeks5.0
Follow-up after hospitalization for mental illness5.0
Alcohol or drug dependence treatment initiated5.0
Follow-up after ADHD diagnosis5.0

2. BlueCross BlueShield – MA PPO plan

Treatment aspectRating out of 5.0
Adhering to depression medication for 12 weeks3.0
Follow-up after hospitalization for mental illness4.0
Alcohol or drug dependence treatment initiated4.0
Follow-up after ADHD diagnosis5.0

This information was taken from NCQA.org, which rates health plans by state. The plans listed are for reference purposes only. They may not be available to you if you reside out of that state. If one of the conditions pertains to you, please check NCQA.org to find a plan with similar benefits.

Tips for selecting a company and plan

There are several resources available to you to help in your decision-making process. Here are some tips:

Tips

  1. Take your time when choosing to enroll in a plan.
  2. Determine what your level of health risk is to help narrow the selection.
  3. For employees under an employer-sponsored health plan, contact your HR rep or the company’s benefits consultant to discuss your unique situation. They can determine which plan suits your needs.
  4. For consumers in the individual market, a local broker can confirm your decision or offer alternatives.

Stephen has over 10 years of experience working in the healthcare industry on both the carrier and broker sides. He has spent his career concentrating on sales effectiveness, ACA compliance, and long-term health and welfare strategic planning as it pertains to group insurance. He is currently working in a business development role at Craford Benefit Consultants.