Calificaciones de calidad
Covered California’s quality ratings show how our health insurance companies compare on helping enrollees get the right medical care and on member-reported experiences of care and service.
Calificación de calidad para 2024
Health insurance companies are rated on a scale of one to five stars. To assign the star rating, each health insurance company's results are compared to about 200 health insurance companies nationwide. A five-star health insurance company means that that company scored among the top plans nationwide; a one-star rating means the company's score was among the lowest.1
* Las calificaciones de calidad se comunican para un producto del plan de salud después de sus dos primeros años con Covered California.
**Not enough data to calculate a score.
Cómo se mide la calidad
Covered California has been reporting quality ratings since day one. These ratings play an important role in helping Californians get better care at affordable prices. A number of California health insurance companies performed well in most areas and no health insurance companies were scored an overall one-star rating. But the performance standards set by the highest-performing plans, in California and nationwide, tells us that some plans can do better.
Covered California está trabajando con sus compañías de seguros de salud para mejorar la calidad y el valor general de la cobertura que ofrecen. Los esfuerzos clave incluyen ver que cada miembro se asigne a un médico de atención primaria; medir el desempeño para un conjunto de medidas prioritarias; alinear los requisitos contractuales con otras agencias estatales de California; identificar y eliminar las brechas en la buena atención entre las poblaciones que difieren por cuestiones de etnia, raza o ingresos; responsabilizar financieramente a los planes para mejorar la calidad y abordar las disparidades de salud; y mejorar la tecnología de atención médica para ofrecer un mejor acceso a la atención.
Covered California provides consumers with an overall quality rating and individual ratings for three major aspects of the health insurance company's performance.
Overall Quality Rating: An overall quality rating is constructed for each health insurance company by summarizing all its quality results. To be rated, the health insurance company must have at least two of the three component scores to include the Getting the Right Care score.
Getting the Right Care: Each year, a sample of members from each health insurance company is selected and their records are checked to compare their medical care with national standards for care and treatments that are proven to help patients. More than 30 aspects of health care quality are tracked by checking patients’ medical charts and the billing records sent by doctors and hospitals. These quality measures include things like how well the health insurance company and its doctors help people control high blood pressure, lower their cholesterol and get the right medications.
Experiencia de atención de los miembros: Las experiencias de los miembros con su médico y atención se basan en una encuesta en la que se les preguntó sobre sus experiencias recientes al visitar al médico y recibir atención médica. Aproximadamente una de cada cinco personas que recibieron una encuesta por correo o por teléfono envió sus respuestas, y alrededor de 250 miembros de cada plan completaron encuestas.
Plan Services for Members: A sample of the health insurance company’s members’ records are checked to see if patients received unnecessary care — services that could be harmful and a waste of your time and money. Another part of the member survey is used to report on members’ experiences in getting help and information from the health plan’s customer service staff.
1 “Plan quality ratings and enrollee survey results are calculated by the Centers for Medicare & Medicaid Services (CMS) using data provided by health plans in 2023. The ratings are being displayed for health plans for the 2024 plan year. Learn more about these ratings at CMS’ Health Insurance Marketplace Quality Initiatives website: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/ACA-MQI/ACA-MQI-Landing-Page.”