The National Committee for Quality Assurance (NCQA) released its 2026 Health Plan Ratings on September 16, scoring almost a thousand commercial, Medicare Advantage (MA), and Medicaid plans on a scale of 0 to 5 stars. Eighteen plans earned 5 stars, up from 11 last year, and five of them are MA plans. The release lands a few weeks before CMS posts the 2027 Star Ratings, and its HEDIS® results come from measurement year 2025, the same measurement year behind the HEDIS® measures in this October's Stars. For your quality team, the NCQA ratings are the first industry-wide look at how that year of data came out.
How NCQA's ratings differ from Star Ratings
The two systems share inputs and little else. NCQA combines HEDIS® clinical measures, Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient experience results, and a bonus for NCQA Health Plan Accreditation. CMS Star Ratings add Part D, administrative, and operational measures, apply their own weights and cut point methodology, and rate at the contract level. NCQA's Medicare CAHPS and Health Outcomes Survey (HOS) results in this release also run a year behind, drawing on 2024 data. A plan's NCQA stars and its Star Rating often differ for these reasons, so the value of the NCQA release sits in the measure-level trends rather than in any predicted Star Rating.
What moved
Performance rose across the board. Average scores improved 1.6 to 1.8 percentage points in every product line, 22 of 28 chronic disease indicators improved year over year, and the gap between high- and low-performing plans narrowed in all three product lines. Behavioral health led the gains, and MA led behavioral health, with Follow-Up After Hospitalization for Mental Illness up 11.9 percentage points in MA compared with 8.9 in commercial and 9.0 in Medicaid. Kidney Health Evaluation for Patients With Diabetes rose 7.3 points in MA.
One chronic care measure moved the other way. NCQA reported diabetic eye exam performance declined, and Eye Exam for Patients With Diabetes carries weight in Star Ratings, so your contract's result on that measure deserves a close read when October arrives.
The overall MA average rating slipped slightly even as commercial and Medicaid averages rose, according to Healthcare Dive's review of the results. All 18 of the 5-star plans are nonprofits, nine of them Kaiser Permanente plans, marking Kaiser's eleventh consecutive year at the top of the ratings. NCQA also reshaped its measure list for 2026, adding two measures, moving three to Electronic Clinical Data Systems (ECDS) reporting, and removing 12, another step in the shift toward digital quality measurement we covered in RISE Radio Episode 34.
What broad improvement means for your cut points
Rising averages combined with narrowing variation is the pattern that pushes Star Ratings thresholds up, because CMS sets HEDIS® cut points from the distribution of contract scores. The draft 2027 cut points already showed HEDIS® as the category where thresholds rose most, and the NCQA results show the same industry-wide improvement from a second vantage point. A contract improving 2 points on a measure while the field improves 1.7 holds its position, and a contract improving less loses ground on the star scale even as its own rate goes up.
Measures where the field slipped work differently. On diabetic eye exams, your year-over-year comparison tells you less than your position against a field that also declined, which is the comparison your Star Rating reflects.
The timing
The 2027 Star Ratings post in early October, and the rating goes to work on three jobs at once, from your 2028 quality bonus payment to Medicare Plan Finder. The NCQA results give your team an industry benchmark for reading those numbers measure by measure the day they arrive. Measurement year 2026 runs through December 31, which leaves this year's data still open, and the hybrid method retirement NCQA has proposed by measurement year 2029 gives your team several reporting cycles to plan the move to fully digital measurement.
The 16th Annual HEDIS® & Quality Improvement Summit covers the road to fully digital HEDIS® by MY 2030, the CY2027 Star Ratings changes, and AI governance in quality, with direct NCQA engagement and 16 measure-specific work groups. Join us November 3-5 in Baltimore.
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