This Guide is intended to help you choose the health plan that is best for you. It will also help you deal with whatever plan you choose so that you get the best possible medical care and service. We give you plan-by-plan ratings, based on several sources.

A key source of information is an extensive survey in which ratings of individual plans were gathered from roughly 20,000 physicians who are currently, or were until recently, affiliated with the plans they rated. These physicians, many of whom have insider knowledge and perspective on what really goes on behind the scenes in plans they deal with, were asked to evaluate the aspects of plan performance that are important to consumers. In many cases, they gave strikingly higher ratings to some plans than to others.

Another source of information is a member satisfaction survey conducted in Spring 2001, in which members of all the rated plans were surveyed using the same basic questionnaire. The surveys were carried out by independent survey organizations, not by the plans themselves. In most cases, the surveys were carried out under extensive and tightly designed quality control procedures set up by the nonprofit National Committee for Quality Assurance (NCQA). We believe member survey data in this book cover more plans than have ever been rated this way in one publication before.

In addition, we have reported which plans distinguished themselves on a set of tightly defined measures of clinical performance—whether immunizations are given to the members who should have them, whether proper disease screening procedures are followed, whether proper medications are given in specific circumstances. And we have also reported plans’ accreditation statuses with NCQA, which is the leading health plan accreditation agency.

You may, of course, wish to choose among plans we have not rated, including many traditional insurance plans. This book advises you on what to look for in any plan. We give special attention to the plan choices available to Medicare recipients and to your rights and benefits within the Medicare program.

Whichever plan you choose, you will need to deal with the plan effectively to assure that you get the care you deserve. We advise you on how to do that.