PAYDAY Workforce Solutions Blog

Covered California Rating System by 4 Stars

Covered California has started providing ratings on healthcare plans as required by law, becoming the first state to do so almost two years ahead of time. The Affordable Care Act allows state exchanges like Covered California to operate for a full year before implementing ratings. Now healthcare plans will have ratings between one and four on pricing and subsidies for consumers who apply on the exchange to compare before enrollment. The ratings are also designed to hold insurance companies accountable and let consumers review their healthcare experiences.

How Are Ratings Determined?

The ratings will come from information gathered from consumers by the Consumer Assessment of Healthcare Providers and Systems, similar to consumer ratings on Amazon and Yelp. They will collect information about insurance companies’ operations, including customer satisfaction and communications, making appointments with doctors and will be rated with stars. The ratings will be highest to lowest, with a 4-star rating being the highest for scores in the top 25 percent of all plans. Lower ratings will include 3-stars for ranking in the 50th to 75th percent, 2-stars for raking in the 25th to 50th percent and 1 star for ranking in the 0 to 25th percent.

When do the Ratings Begin?

Although the Affordable Care Act gives state exchanges until 2016 to start ratings and California officials announced in August 2013 they wouldn’t start ratings early because they didn’t think enough data would be available, they have changed their minds at the urging of some health insurers, health policy groups, consumers and exchange board members. Preliminary ratings will begin now and will develop into full ratings on all health plans. Other states are waiting for federal guidelines before implementing ratings.

How Will Consumers Access Ratings?

Covered California has added the quality rating system (QRS) to its website for consumers to review before they decide which insurance plan to enroll in. The QRS presents ratings from data collected from consumers by the Consumer Assessment of Healthcare Providers and Systems. CAHPS administers a standardized survey to measure consumers’ experience with health plans. Two health plans have four stars already: Kaiser Permanente and Western Health Advantage. Anthem Blue Cross Blue Shield, one of the biggest opponents of the Affordable Care Act and a major insurer in the state, has three stars. The new ratings are from 2012 data by region since the system doesn’t have more current data yet. The ratings will evolve over the next two years to provide ratings that are based on richer, consumer-provided reviews collected by CAHPS.

For help navigating the Covered California process, please contact our sister company, Beneforce Insurance Solutions. A Covered California certified agent can assist with questions, enrollment and any other Covered California or ACA topics.

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