Top 10 Private Health Plans « Health Insurance Advisory

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new healthcare reform lawThe new healthcare law, called the Patient Protection and Affordable Care Act (PPACA), represents comprehensive healthcare reform legislation signed into law on March 23, 2010. It contains numerous provisions designed to protect consumers and promote low cost medical insurance, including many new taxes to pay for the cost.

In this section of the site, you can also obtain the following information specific to your state: available medical insurance options, efforts to regulate medical insurance premiums, healthcare, the individual medical insurance marketplace and the new healthcare law.

Our objective is to help Americans make sense of the new healthcare law by explaining key provisions in plain English and assisting individuals, families and the self-employed in using this information to find and secure affordable medical insurance.

Top 10 Private Health Plans

Author: Pete S - Sr. Staff Writer | Oct 02 2011 | Colorado, Florida, Maine, Massachusetts, New Hampshire, Pennsylvania, Rhode Island, Wisconsin

The National Committee for Quality Assurance (NCQA) recently published the results of their annual survey, called “NCQA’s Health Insurance Plan Rankings.” It evaluated 390 health plans in three categories: 1) Medicare, 2) Medicaid and 3) Private (commercial) Health Insurance Plans. While the rankings are predominantly focused on quality, consumers must still do their own homework to determine if a particular health plan provides affordable medical insurance.

For individuals seeking enrollment in a Health Maintenance Organization (HMO), this report is useful because it provides information, such as overall member satisfaction, quality of medical care provided and emphasis on wellness/ prevention. Unlike a traditional Preferred Provider Organization (PPO) where there is more control and flexibility over healthcare treatment (not required to select a primary care physician or obtain a referral to see a specialist), you have less choice, freedom and flexibility with HMOs. As a result, you want to confirm the HMO health plan provides high quality care and receives satisfactory rankings from its existing members.

If you need assistance understanding the many different types of health insurance, visit our Medical Insurance Research Center. You will find a health insurance glossary of terms and a medical insurance Buyer’s Guide and Checklist that provides handy tips regarding how to secure low cost medical insurance.

The rankings are based on the combined scores for health plans in Healthcare Effectiveness Data and Information Set, commonly called HEDIS; the Consumer Assessment of Healthcare Providers and Systems, or CAHPS, and NCQA Accreditation standards score. Consumers and employers assess plans assess plans prior to annual enrollment periods.

While this is the sixth year of the survey, historically, only HMOs were evaluated. This year, however, marked the entry of PPO Plans to the survey.

The top 10 Private Health Plans for 2011 are:

  1. Harvard Pilgrim Health Care (HMO/POS Plans) – serving Maine and Massachusetts, this health plan earned a near perfect score for prevention services
  2. Tufts Associated Health Maintenance Organization (HMO/POS Plans) – serving Maine, Hew Hampshire and Rhode Island, this health plan received high marks for consumer protection, quality improvement and clinical effectiveness. It also has the highest enrollment in consumer driven health plans in the state
  3. Capital Health Plan (HMO Plan) serving residents primarily in Tallahassee, Florida and the surrounding areas, this health plan earned the highest consecutive overall ranking for all categories evaluated
  4. Tufts Health Plan (PPO Plan) – serving Maine, New Hampshire and Rhode Island, this is the first PPO Plan to earn a top spot in the report
  5. Harvard Pilgrim Health Care of New England (HMO /POS) – serving Massachusetts and Maine, this health plan touts direct contact with members across three states and overall excellent communication
  6. Kaiser Foundation Health Plan of Colorado (HMO Plan) – serving Colorado, this health plan, ranked high for consistent quality improvement and relentless drive toward achieving the highest quality healthcare possible
  7. Group Health Cooperative of South Central Wisconsin (HMO Plan) – serving Wisconsin, this health plan is recognized as having the highest ranking in quality among all managed healthcare organizations in the state
  8. Geisinger Health Plan (HMO/POS Plan) – serving residents of 43 counties throughout central and northeastern Pennsylvania, this health plan is one of the nation’s largest rural HMO’s
  9. Harvard Pilgrim Health Care (PPO Plan) – serving Massachusetts, this health plan earned near perfect ratings for prevention services. Also, it is the highest ranked health insurance plan for overall member satisfaction in the New England Region according to J.D. Power and Associates 2011 Members Health Insurance Plan Study
  10. Health New England (HMO /POS Plans) – serving western Massachusetts, this health plan ranks highest in customer satisfaction.

As a private 501(c)(3) not-for-profit organization, NCQA’s purpose is to improve health care quality. Since 1990, NCQA has been a central figure in driving improvement throughout the health care system, helping to elevate the issue of health care quality to the top of the national agenda.

For online health insurance quotes from these and other health insurance companies and medical plans, click here.

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