Health insurance

Which plan to pick? New rankings show big quality differences.

Until the health reform law's major provisions finally take effect in 2014, choosing and affording health insurance will remain a vexing chore for many. You may be tempted to opt for a familiar brand name. But that might be a mistake, unless the brand is Kaiser Permanente.

Our analysis of the rankings of more than 800 private, Medicare, and Medicaid health-insurance plans from a respected independent quality-measurement group, the nonprofit National Committee for Quality Assurance (NCQA), finds that a national brand is no guarantee of quality.

The five largest insurers—Aetna, Cigna, Humana, Kaiser Permanente, and UnitedHealthcare—together with the 60 mostly state-based Blue Cross Blue Shield plans account for 75 percent of the 390 ranked private plans but only 36 percent of the top 50. (Private plans are those that people obtain through an employer or buy on their own.)

Digging deeper, we found wide variations not only among brands but within them. For example:

Biggest doesn't equal best

With almost 33 million enrollees, UnitedHealthcare is the nation's largest health insurer. But none of its plans rank among the top 50 private plans, only three are in the top 100, and most occupy the bottom half of the rankings.* Few of its Medicare HMOs and PPOs made it into the top 100 of the 341 ranked Medicare plans.

Small can be good

Some of the top-ranked insurers are smaller, community-based, and mostly nonprofit. Capital Health Plan, a Blue Cross Blue Shield HMO in Tallahassee, Fla., that has just 113,300 enrollees, ranks third in the nation among private plans. Tufts Associated HMO and Tufts Health Plan, a PPO, are ranked second and fourth, respectively, among private plans; they have a combined 718,200 enrollees in Massachusetts, Rhode Island, and New Hampshire. And Group Health Cooperative of South Central Wisconsin, with 64,300 enrollees, is ranked seventh.

Cigna's PPOs score poorly

Though several of Cigna's HMOs rank in the top 100 of 390 ranked private plans, its PPOs scrape the bottom of the barrel, with rankings below 300, in part because they are still in the process of being accredited. Cigna enrolls more than 11 million people nationwide.

New England shines

Eighteen of the 50 top-ranked private plans are in that compact six-state region. And Aetna and the "Blues" had New England plans ranked in the top 100, while many of the same insurers' plans in southern and western states ranked near the bottom of the list.

Kaiser makes the grade

Almost all of Kaiser Permanente's private and Medicare HMOs scored better than average for treatment and prevention and were among the highest ranked nationally. For example, its Medicare plans in California, Colorado, Oregon, and Washington topped the rankings. Kaiser enrolls about 8.8 million people nationwide.

This is the second year that we are publishing the NCQA insurance plan rankings. Insurance plans in all 50 states and Washington, D.C., are ranked, including 540 HMOs, 285 PPOs, and five HMOs and PPOs whose owners operate them separately but report combined results. Together those plans enroll an estimated 127 million Americans in private coverage, Medicare, and Medicaid.

The NCQA is ranking PPOs for the first time this year. PPOs, which have less restrictive network rules than HMOs, enroll about 34 percent of the U.S. population and 60 percent of those covered by large employers. HMOs enroll 31 percent of the population. (Which plan is right for you? See How to choose a health plan.)