BEST FOR MEDICARE ADVANTAGE
An impressive 36 Aetna Medicare Advantage plans sold in 30 states, plus the District of Columbia, received top NCQA ratings (4.0 or greater) in 2021, with Connecticut and Maine being standouts.1 In 2020, Aetna Medicare Advantage Prescription Drug plans were made available in 264 new counties across the country, providing millions more Medicare beneficiaries access to an Aetna plan.
The insurer also sells Medicare supplement plans (Medigap) in all 50 states. In addition to these, they also offer a combination dental, vision, and hearing supplemental Medicare product in many states.
In the private arena, Aetna is a large provider of employer-based health insurance. A total of five Aetna plans serving Iowa, Pennsylvania, Wisconsin, and Rhode Island made the top NCQA ranks in 2021, and the 2021 J.D. Power U.S. Commercial Health Plan Study ranked Aetna plans second-highest in Ohio, Maryland, and Virginia. In addition, Aetna’s pricing seems to be lower than many competitors’ pricing.
In November 2018, Aetna became part of CVS Health Company, and synergies between the two are beginning to emerge. For example, Aetna medical plan subscribers with high blood pressure can get a free home monitor at CVS. Chronic disease monitoring may also be available at CVS stores.
BEST FOR NATIONWIDE COVERAGE
Blue Cross Blue Shield
One out of three Americans has health coverage from Blue Cross Blue Shield. The names on various state plans include Anthem, CareFirst, Highmark, Independence, and Wellmark, but the 34 independent and locally operated Blue Cross Blue Shield companies open doors in all 50 states, Washington D.C., and Puerto Rico. Nationwide, more than 1.7 million doctors and hospitals contract with Blue Cross Blue Shield companies—more than any other insurer, according to the company.
In 2021, 57 Blue Cross Blue Shield company plans earned moderate to high ratings from NCQA based on clinical quality and member satisfaction. In 2019, many Anthem plans—including some with lower overall ratings—scored impressively in areas related to customer satisfaction.3 Blue Cross Blue Shield offers employer insurance, individual policies on healthcare.gov, and a variety of Medicare plans (Medigap, Prescription Drugs Part D, and Medicare Advantage).
BEST FOR GLOBAL COVERAGE
It’s not surprising that a company that sells a product called Global Health Advantage would lead our list for international coverage. This global health service company has 17 million medical customers worldwide served by a global network of 1.5 million healthcare professionals with access to doctors in 200+ countries.
It has more than 70,000 employees. Cigna followed on the heels of Aetna and CVS Health in 2018 by partnering with Express Scripts, the nation’s largest pharmacy benefit manager, in a deal aimed at lowering costs and improving care.
In the U.S., six Cigna plans received a four-star rating in 2021. However, Cigna was a top performer in customer satisfaction in Illinois/Indiana, Virginia, New Jersey, and Ohio in the 2021 U.S. Commercial Member Health Plan Study by J.D. Power, it was ranked among the worst in its industry for member satisfaction by the American Customer Satisfaction Index (ACSI) in 2020.
Cigna sells medical plans in 12 states and dental plans in all 49, plus D.C. It sells individual plans on healthcare.gov in 313 counties across 13 states. Cigna also expanded its Medicare Advantage plans in 2021 to reach a total of 477 counties across 26 states (plus D.C.), adding coverage in three new states for 2022.
BEST FOR UMBRELLA COVERAGE
Health insurance policies don’t usually cover such expenses as eyeglasses and contacts; or dental exams, crowns, and appliances. Humana, a broad-based health and well-being company, sells private policies in all these areas, and the company has a range of plans for people living with chronic conditions that include transitions from a hospital stay to home care and meal delivery.
Humana is also among the companies that offer special needs policies for people with a severe or disabling chronic condition or living in a long-term care facility. As of 2018, Humana no longer offers individual medical plans but focuses on healthcare solutions for employers and offers Medicare plans.
Twenty-four Humana plans received a four-star or better rating from the NCQA in 2021.1 Humana led the pack for customer satisfaction among health insurers in 2020, according to data from the ACSI survey.4 Humana’s policies for HMOs are relatively affordable.
BEST FOR HMOS
Kaiser Foundation Health Plan
The nonprofit insurer Kaiser Foundation Health Plan Inc—part of Kaiser Permanente—won stellar ratings for private insurance, with one plan (Mid-Atlantic States) getting a top overall NCQA score of 5.0 and seven other plans, ranging from Georgia to California, winning 4.0 to 4.5 ratings.
In the Medicare Advantage arena, Kaiser was also a winner with eight plans in the very top echelons.1 The company operates in eight states (California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington) and Washington, D.C.
All of Kaiser’s highly rated private and Medicare Advantage plans are HMOs (except for one plan in Washington state). This is good news for those needing budget health insurance because HMOs have lower premiums, no deductibles, and lower copays and prescription drug costs.
The downside to an HMO is the stipulation that—except in emergencies—you must use only doctors, hospitals, and other services that are in the network. The plans do, however, deliver the same essential goods as a PPO plan. Kaiser’s policies have relatively low premiums.
BEST FOR THE TECH SAVVY
Want to track your health on an Apple Watch? File claims, set up doctor appointments, and find doctors online? United Healthcare’s 2019 Annual Survey found that 37% of consumers shop for health care on a computer or with mobile apps. The company is pushing “consumer-driven digital health care,” which includes wearable technology for glucose management, smart baby monitors for high-risk infants, and activity trackers that allow fitness participants to win monetary awards.
Two private United Healthcare plans (one in Rhode Island, the other in Minnesota) scored an impressive 4.5, while nine plans in D.C. and seven states (North and South Dakota, Iowa, Massachusetts, Nebraska, New York, and Wisconsin) scored 4.0 in overall NCQA ratings. An impressive 29 of its Medicare Advantage plans were highly rated, including several sold under the name Sierra Health and Life Insurance Company, Inc.
United offers the full spectrum of health benefit programs for individuals, employers, and Medicare and Medicaid beneficiaries. It contracts directly with more than 1.3 million physicians and care professionals as well as 6,500 hospitals and other care facilities nationwide. Both HMO and PPO plans are available with access to health savings accounts (HSAs) and flexible spending accounts (FSAs). Its policies may cost a bit more than some of its competitors, but it may be worth it for the extra features.
BEST FOR THE MIDWEST
Under the names Group Health Plan, Inc and HealthPartners Insurance Company, this company sells plans in Minnesota, Wisconsin, North Dakota, South Dakota, Iowa, and Illinois. All three of its private plans garnered 4.5 overall scores from NCQA.1 Those who have diabetes may like this plan, as one of HealthPartners’ promises to consumers is to provide monthly insulin supplies for no more than $25.
Overall, the company offers three separate plans in Minnesota and two separate plans in Wisconsin, depending on where you live and your specific coverage needs. Those living in the HealthPartners Insurance area of Minnesota have the most options available.
BEST FOR NEW ENGLAND
This New England not-for-profit company has 4.5-rated plans in two states (Maine, Massachusetts) and a 4.0-rated plan in New Hampshire.1 The Harvard Pilgrim Passport and Access America plans are offered jointly by Harvard Pilgrim and UnitedHealthcare, allowing members access to a gigantic network of doctors nationwide, thousands of hospitals, and flexible health benefits.
BEST FOR NEW YORK
Capital District Physicians’ Health Plan
This physician-directed health plan has some of the highest-rated plans in the business. Their private plan scored a 5.0 in overall score from NCQA and was one of only eight private plans nationally to achieve a perfect score in consumer satisfaction. CDPHP’s Medicare and Medicaid plans were also high scorers, coming in at 4.5 stars. The plans are available in 29 of New York’s 62 counties. The company notes that eight out of its 15 board members are physicians.
What Does Health Insurance Cover?
You will find that health insurance coverage ranges pretty widely from one insurance provider to the next, and even between the individual plans offered by a provider. But while your exact options vary, there are some mandatory coverage standards that every health insurance policy must provide.
Thanks to the Affordable Care Act, there are 10 categories of health services that all healthcare.gov insurance plans are required to cover, called essential health benefits.6 These include pregnancy and childbirth services, prescription drug coverage, mental health services, outpatient hospital care, preventative care, emergency services, and more. Plans must also provide dental coverage to minors (adult dental coverage is optional).
This coverage’s exact details and limits may differ from one state to the next. Also, large companies that self-insure employees are not required to follow these same standards, though many still do. You’ll want to check with your employer’s plan to see exactly what is covered if you are offered health insurance through your job.
Is Health Insurance Required?
When the Affordable Care Act was first passed, it included a health insurance mandate; if you could afford adequate health insurance (“minimum essential coverage”) throughout the year but chose not to purchase it, you were required to pay a penalty fee. This fee was usually charged when it came time to file that year’s taxes and was imposed on everyone in your household who did not meet the minimum healthcare requirements.
However, beginning with the 2019 plan year, this penalty—called the Shared Responsibility Payment—was reversed on a federal level. You are no longer responsible for this fee if you choose not to carry minimum coverage, and no exemption is necessary to avoid the penalty.
However, some states still have their own health insurance coverage requirements. Be sure to check the laws in your state of residence to see what level of insurance you’re required to carry and what penalties, if any, apply for not meeting these minimum standards.
How to Determine the Best Health Insurance Plan?
Buying health insurance can be an arduous and confusing process, especially when there are so many options and costs to consider.
There are a few questions to ask yourself if you want to make the search a bit easier. They include:
- Does my employer offer coverage, or will I need to shop in the Health Insurance Marketplace? A workplace plan, if offered, may be more affordable than buying an individual plan.
- How often do I anticipate using my coverage? If you only see the doctor for routine/preventative care, you’ll need a very different plan than someone who has a chronic condition or a child with disabilities.
- What sort of costs can I expect to encounter? You typically have two options to choose from: a high deductible or higher premiums. If you don’t expect to use your coverage much—and can afford the out-of-pocket cost if you do wind up needing serious care—a plan with a high deductible can save you money all year long. On the other hand, if you and your family are at the doctor’s office often, paying a bit more for premiums in exchange for a lower cost-share/deductible may be the less painful option.
- Will I be able to see my doctor(s)? If you enjoy seeing your current providers, you’ll want to make sure that they accept your new plan before switching, or you’ll need to find new doctors.
- What if I need emergency care (especially when traveling)? Be sure to read the fine print and coverage options before picking a plan, particularly if you’re often in other states. Some plans have stricter guidelines than others when seeking care while away from home.
Depending on whether you are choosing an employer-based plan or shopping on the Marketplace, you may also want to compare PPO vs. HMO options. You should also consider whether you need a plan that also provides dental or vision coverage.
How Much Does Health Insurance Cost?
As with any insurance product, there are countless personal factors that go into calculating your cost for coverage. When it comes to health insurance premiums, you also have to take into account the difference between employer-sponsored plans and those purchased on the Marketplace, the difference between coverage for a single person and that for a family, and whether your income qualifies you for a tax credit on your Marketplace plan premiums.
There are a few factors that go into calculating your health insurance cost across the board, though. These include your age, location, plan category, individual vs. family enrollment, and whether or not you’re a tobacco user.
For instance, whether you’re buying an employer-sponsored plan or one on the Marketplace, you can expect your premiums to go up by as much as 50% if you smoke or vape.7 When you consider that annual healthcare premiums are already an average of about $7,470 for single folks and $21,342 for families, an extra 50% could feel significant.8
How We Chose the Best Health Insurance Companies
We examined the 126 health insurance plans that were top-rated by NCQA, the National Committee for Quality Assurance, a non-profit rating group, and aggregated them by insurance company. We then narrowed the list to companies with highly-rated plans available in multiple states. To make the best list, most companies also had to have at least an A- financial rating from AM Best, Fitch, or Standard & Poor’s.
We then took a qualitative look at our nine highly rated companies to identify special strengths that might appeal to the priorities of different types of consumers. We examined how the companies were rated in NCQA subcategories in the 2020 ACSI (American Customer Satisfaction Index) survey of roughly 500,000 consumers and in the 2021 J.D. Power customer satisfaction survey of 32,066 commercial health plan members. We looked at company profiles and Top Ten Reviews to evaluate the depth and breadth of the company’s coverage offerings and pricing for individual and employer-based insurance, Medicare Advantage, and other types of policies.
We also looked at availability—the number of doctors, hospitals, and medical systems that contract with (or accept) a particular insurance company’s coverage—and types of coverage offered. And we considered where these insurance companies operate and whether plans can be purchased on healthcare.gov.
Pricing was an important factor in our consideration, and lastly, we considered the number of plans offered and what sort of coverage limits consumers were able to choose from while shopping around for their health insurance.