Unaccredited plans lose ground in the NCQA rankings because accreditation counts for up to 15 points out of a possible 100. Here’s why.
During the accreditation process, evaluations by physicians and managed-care experts make sure not only that the plan has the right policies and procedures but also that the plan is following them. Do the plans provide accurate marketing material? Do they give clear information to members on coverage and denial decisions? Do the providers in their networks have proper credentials?
“It’s not enough to have an appeals process,” says Andy Reynolds, an NCQA assistant vice president. “The on-site survey looks to see how the plan executes it.”
Accredited plans also commit to being held accountable for their performance by reporting data on it. Experience has shown that when plans report on their performance, it usually gets better. In fact, the health care reform law will require that any plan sold through exchanges in 2014 and beyond must be accredited.
A total of 254 ranked plans are not accredited, of which 22 are scheduled for accreditation and two were going through the accreditation process as we went to press. There are a number of reasons a plan might skip NCQA accreditation, including the expense—plans pay a fee to the NCQA for it. Plans might be accredited by another organization, again for a fee. Many more Medicare and Medicaid plans than private plans are not accredited.
All unaccredited ranked plans do submit some quality and consumer satisfaction data, so you can compare both types of plans in your area.
Read more about accreditation and what's behind the NCQA rankings of health insurance plans.