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How To Choose a Health Plan
Each year, millions of Americans are asked to choose a new health plan or continue their enrollment in an existing plan.
Health plan choice is one of the decisions that will most heavily influence the quality of your care. Taking the time to research your choices is a wise, and worthwhile, effort. Following a few simple guidelines can help you in your effort to find quality health care.
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Look for NCQA Accreditation:
Health plans accredited by NCQA have proven themselves against a rigorous test of quality. The care and service the plan provides have been evaluated against NCQA’s high standards. Because the plan met or exceeded the standards, it achieved NCQA Accreditation.
Check to see if your health plan is NCQA-Accredited on the Health Plan Report Card. By choosing a plan with NCQA Accreditation, you can be assured that an independent third party has closely evaluated the plan on areas of service, clinical quality, structure and operations.
If your health plan is not accredited by NCQA, click here for more information.
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Compare health plans on NCQA’s Health Plan Report Card:
NCQA’s report card tells you how plans rate in five important categories: Access and Service, Qualified Providers, Staying Healthy, Getting Better, and Living with Illness.
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Match Your Needs to a Health Plan’s Strengths:
The NCQA report card allows you to compare multiple plans side by side. Decide which areas of care and service are most important to you and see how each plan’s performance matches up. Your health and that of your family will help you determine your priorities.
If two plans that you are considering are accredited at the same level, look at the stars for each category. If a certain category is more important to you, you may find one plan does better than another.
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Weigh Other Factors:
Take advantage of the information the NCQA Health Plan Report Card gives you. In addition, each health plan can provide you with information either through their Web site or by contacting the plan’s customer service department. You might consider:
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Doctors and Hospitals:
Are the doctors and hospitals you prefer included in the plan’s network? Are those doctors and hospitals near your home or work?
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Benefits and Services:
How well does the plan cover you and your family’s health needs—the ones you can anticipate, as well as potential emergencies? Does it offer prenatal and maternity care? Is prescription medicine covered?
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Value:
How much will you need to pay out of your own pocket in the form of co-payments (including doctor’s visits and prescriptions)? What’s your monthly premium? Is there a deductible?
NCQA also offers other assessment programs for physicians and other health care organizations that evaluate health plan quality. Click here to view the other programs.
A health plan may not be listed on this site for any of these reasons:
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Plans use many different names in the different areas they serve. If your plan is not listed,
be sure to review the list of additional names your health plan may use to see if it is included under a
different name on our report card. Additional plan names are listed under the plan name on the search results page.
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Some health plans choose not to participate in NCQA’s programs. Enrolling in an NCQA Accredited plan is one of
the best ways to ensure that you and your family will get the care, service and consideration you need,
when you need it. Contact your plan to see if they have applied for and received NCQA Accreditation.
If a plan chooses not to be reviewed by NCQA, you should ask: Why not?
If you receive health care coverage through your employer, talk with them about offering NCQA-accredited
plans. Health plans are more likely to focus on quality and seek accreditation if encouraged to do so by
health plan members and employers who make decisions about which plans to choose.
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